§ Mr. John P. Mackintosh (Berwick and East Lothian)
Hon. Members may wonder why it is necessary to seek a debate on this subject at this time. They will know that, as a result of a Bill brought in by my hon. Friend the Member for Bebington (Mr. Brooks), it is now proper for local authorities in England and Wales to set up family planning clinics and for those clinics to give advice and assistance on family planning free of charge on medical grounds and with a charge, if necessary, on social grounds
Therefore, not only have the Government supported my hon. Friend's Bill, but they have identified themselves completely with the notion of a proper family planning service. Moreover, the Secretary of State for Social Services was invited to make the opening speech to the Family Planning Annual Conference and then he said:I certainly do not need to preach to you about the benefits conferred on the community by a good family planning service. But I should like to stress the very great importance which I attach to this development. It 1751 is my avowed aim eventually to provide comprehensive family planning within the National Health Service.So we have a situation in which the Government are identified with the notion of family planning facilities and advice being made available to those who desire them.
Yet there is the peculiar anomaly, which is not wholly appreciated in the rest of this country, that Scotland is not in this position and was deliberately excluded from this legislation. It is worth pointing out how this happened, because this is the situation which I am now asking the Minister to remedy.
When my hon. Friend the Member for Bebington (Mr. Brooks) was preparing his Private Member's Bill, it was originally intended to apply it to the entire United Kingdom. Provision was to be made throughout the country. But during the course of discussions he encountered some opposition from the Scottish Office and he found that it would be easier to proceed if the Scottish part of the Bill were dropped, but he agreed to drop it only on the understanding that there would be separate legislation shortly thereafter to deal with the Scottish situation.
This is not uncommon. The original Scottish National Health Service Bill came a year after the similar Bill for England and Wales. In the circumstances, my hon. Friend, whom I am glad to see in his place, decided to leave Scotland out of the operation of his Bill.
Later, my hon. Friend the Member for Aberdeen, South (Mr. Dewar) wanted to bring in a Ten-Minute Rule Bill and he, too, was advised not to do so, because legislation on the subject was shortly to be introduced by the Government. This legislation was introduced. It was the Health Services and Public Health Act, 1968. Section 15 applied solely to Scotland and gave the Government power to permit local authorities to provide in Scotland the family planning facilities which local authorities are currently permitted to provide in England and Wales.
The peculiar thing that happened was that local authorities then received from the Scottish Office Circular 21/68, which said:in the light of the present economic situation it has been decided to defer for the present bringing this Section into force".1752 As a result, Scottish local authorities were warned off this activity. It is this circular, which I am asking the Government to withdraw, so as to allow Scottish health authorities to play the same part as their counterparts in England and Wales.
It may be argued that the fact that this power does not exist does not prevent a certain amount of family planning advice on other than purely medical grounds from being given in Scotland, and that is true. The citizen may now get such family planning advice and assistance from a general practitioner, a hospital, a private consultant, certain family planning associations clinics, from two local authority clinics and from the Brook Clinic. But, in practice, all this adds up to very little.
The general practitioner, for instance, may charge for writing prescriptions and for advice, but not for examination, and the average charge in Scotland for this at the moment is 10s. 6d., although many general practitioners give free advice although anything which they prescribe has to be paid for. Private consultants clearly charge and have a very limited clientele.
Post-natal clinics of hospitals are entitled to give this advice and practical family planning assistance in the form of devices and so on free of charge. This is a curious anomaly, but again, in practice, it applies only to that limited group of people who know the problem and who ask specifically for this type of assistance.
The Family Planning Association clinics have done a tremendous amount of work, but they are finding that costs are rising, as is found by most private organisations, and they are running on a shoestring and often, although they would like to give assistance, they cannot do so. The most curious anomaly of all, which ought to concern the House, is the fact that there are cases where the Family Planning Association is not able to give free advice and help—cannot prescribe and offer assistance to prevent a pregnancy—but on the day after the pregnancy occurs, an abortion can take place under the National Health Service.
We find this situation increasingly intolerable. I want to push it before the Government and get them to act. There are two other local authority clinics set up, more or less under private initiative, 1753 by the authorities, one at Aberdeen and one at Inverness. The Aberdeen clinic makes no charge, the Inverness clinic does, for certain categories. The total effect of the present provision of family planning advice in Scotland is that it reaches only that limited group which knows what it wants, seeks it out and asks for it. Thus it tends to be confined to those sectors of the community which inherently are not the problem sectors, where the need is not so serious due to social difficulties and where ignorance and family circumstances do not play a great part.
Why should we urge the Government to act now? I do not want to argue the general case for family planning, because it has been argued before. We do not now need to do a major job of convincing people. It is accepted that contraception is a matter for the individual conscience, but where people wish to have advice it should not be withheld artificially through difficulties created by the State, by lack of permission or of financial assistance. The result of the present situation in Scotland is in many ways alarming. Consider the illegitimacy rate. It has been rising steadily in the last four years.
In 1964, there were 5,628 illegitimate births; in 1965, the figure rose to 5,883; and in 1966 it was over the 6,000 mark. In 1967, it had risen to 6,663. In percentage terms, illegitimate births had risen, as a percentage of live births, from 5.4 per cent. to 6.9 per cent in these four years. There has been a rise in the number of abortions, and the figures have been given by the Secretary of State. I appreciate that in the past some of these abortions may have been illegally carried out or carried out privately outside the National Health scheme. Virtually all abortions in Scotland are now performed under the Health Service. But it remains true that the number of abortions has risen since the Act was introduced from 190 a month in 1968 to 230 a month in 1969.
I put these figures not for any moral argument, but to deal with the argument contained in the circular, that the reason why family planning advice cannot be extended is an economic one. Let us look at this fantastic argument. I am putting aside the tremendous costs in emotional terms, with which I do not need to deal because we are all aware of 1754 them. I am looking at it purely from the angle of the financial argument raised by the Government. Let us consider the cost of these extra illegitimate births and abortions to the community in toto. Luckily, we have some figures.
Southampton City's local health authority produced admirable figures of its family planning service. It pointed out that it had a designated group, as most local authorities do, of problem families. In the year before the service was introduced, these families had 142 children. After the service was introduced the figure was down to 38—there were 110 births fewer in that group. This does not take into account the reduction that there might have been in other groups in the area. Taking this problem group alone, and looking at it from an economic point of view, the 110 births which did not take place resulted in a saving in one year to the Exchequer of £2,775 in maternity grants, family allowances and welfare grants. It saved the local authority £5,678, judging by the numbers, in past years, of these children which had to be taken into care.
Indeed, the saving to Southampton was about £8,000 a year. If that continues for only a few years, the cost of the family planning service there is paid for several times over. The net saving to the community is, in 15 years, about £70,000. Dr. Ian MacQuen, of Aberdeen, who is well known in this sphere, since Aberdeen has the only major clinic operating in this area in Scotland, reckons that for every £ spent in Aberdeen on family planning there is a saving of £4 to the community. The family planning service operated by him costs only £10,600 per annum.
I am not looking at this emotionally or morally, because we haw debated these aspects. I am sticking to the argument that the Government have bought up in their Circular, that the economic situation prevents them extending the Act. I submit that there is no case for this. I would continue to press for these services even if they were loss-making, on moral, personal and emotional grounds of allowing people to have wanted children, when they wanted them, and none other. The economic case made by the Governement falls to pieces.
A second argument was that there was no evident demand for this in Scotland. I deny this. It is ridiculous to 1755 expect local authorities to come clamouring for this power. It is clearly low down in comparison with houses, roads, schools, etc., as an immediate pressure. What we can see, however, is that in the brief period since my hon. Friend the Member for Bebington introduced his Bill making this possible in England and Wales, out of 204 authorities, 34 have set up an entirely satisfactory service, 129 have set up a reasonable or restricted service, and only 40 authorities have done very little. It is clear that where this permissive power is given there is a demand for it, and it is carried through.
The final difficult problem is who opposes the carrying out of this Section of the 1968 Act? Are the people opposed to it? The evidence of the Gallup Polls in Scotland is glaring—there is an overwhelming demand for family planning advice. Even on the most controversial ground, whether birth control advice should be available to unmarried women, there is a majority in Scotland of 43 per cent. in favour as against 36 per cent. against according to the latest poll.
I know that there is a strong religious group in Scotland with deep conscientious objections to family planning, and I respect it. This group pays great attention to social problems in its parochial advice, in its care for families, and its people. It is a group that I admire and with whom I co-operate in my constituency. But I know of very few Catholics who would argue that for the non-Catholic population who do not have these conscientious views unwanted pregnancies and abortions are better than available advice. Any Government who press ahead with this will find that it is something which is reasonable and regarded as quite proper. The public regard the present situation as anomalous and are surprised that this Government should not be acting. I have already read out the wholehearted support for family planning in the speech of the Secretary of State. The Government are supporting the family planning association in England and Wales and contributes £20,000 a year to aid its training programme. It is carrying out research on this question and the Minister wants to make family planning a normal part of the Health Service. What is wrong with Scotland? Why are we having a different policy there?
1756 The 1966 Labour Party conference overwhelmingly accepted this policy. It was passed nemine contradicente. The right hon. Lady the Member for Leeds, South East (Miss Alice Bacon) who replied to the debate on behalf of the National Executive Committee accepted this as official Labour Party policy. Therefore, I cannot see that there is any party opposed to it, certainly not the majority party. Even those who are very worried about permissiveness in Britain and who are worried about the operation of the Abortion Act favour family planning.
In The Times today there is a letter by the President and Secretary of the Royal College of Obstetricians and Gynaecologists, which has been deeply worried about the working of the Abortion Act. Despite that concern, the penultimate paragraph of Sir John Peel's letter contains this sentence:A really effective and centrally financed family planning programme is an urgent necessity in this country.So I cannot see who is opposed to this simple administrative change which on financial grounds pays for itself over and over again.
Whilst thinking about this matter earlier this week, I went home and found my television set was on at the time, and a programme which some hon. Members may have seen called "Dr. Finlay's Casebook" was being shown. On the screen an argument was taking place on the precise point as to whether a family planning clinic should be set up in that little Scottish burgh. The arguments canvassed were the sort of things we are now discussing in the House. But the startling fact is that the serial is set in the 1920s and we are now in 1969. Forty years later and we have not moved on. We have a Tannochbrae situation here in the context of family planning in Scotland.
I do not wish to cast my hon. Friend the Under-Secretary as Dr. Snoddie, the reactionary gentleman in the serial. I know that my hon. Friend is a man of liberal and progressive views, but he and the Secretary of State between them have concocted a new version of the doctrine of "unripe time". When I have written to my hon. Friend asking him whether he would consider implementing this Section in the Act he has written back saying, "I agree entirely with what you propose 1757 and with family planning, but do not press. It is coming very soon. Just do not make it more difficult. Be patient now". So I was patient for a considerable time.
But then, when I asked my right hon. Friend the Secretary of State for Scotland in the Scottish Grand Committee on Tuesday, 8th July, why he was not doing anything, he said, "I am not doing anything because no pressure is being brought to bear upon me to do so". Between the two of them the Secretary of State and the Under-Secretary have managed to keep this game up for a considerable period, until we are now forced to apply the pressure.
The case is an open and shut one. We know what we want. The public knows what it wants. The powers are there. The value is clear. I ask my hon. Friend not to do what is so often the current political habit—that is, to attempt to defend the indefensible and then slip through a concession in a few months' time. I ask him to concede this case immediately.
§ 4.52 p.m.
§ Mr. Alick Buchanan-Smith (North Angus and Mearns)
I congratulate the hon. Member for Berwick and East Lothian (Mr. Mackintosh) on having raised this topic. I support him whole-heartedly in his plea for the provision of these facilities in Scotland. There is a tremendous need for proper education and advice to be available, in addition to the provision of facilities.
At the time that the hon. Member for Roxburgh, Selkirk and Peebles (Mr. David Steel) introduced his Bill, there was a case for the abortion law being reformed. I am alarmed if the opportunity for abortion is made, as the hon. Member for Berwick and East Lothian said, an excuse for the failure to provide or to make use of proper family planning services. I wholly support the hon. Gentleman's argument that it is much more important to provide family planning facilities than it is to provide hospital attention for abortion later.
I do not believe that the provision of family planning advice and facilities should be made any excuse for promiscuity or allowed to be a licence for such. One of the greatest disservices that can be done to an unmarried girl 1758 is for her to be made to think that the provision of contraception is an excuse for immorality. What can be exciting and adventurous, perhaps, at one time can lead to unhappiness and lack of fulfilment in marriage later. In any case, apart from any question of morals—there are morals involved, as the hon. Gentleman said—there is the very disturbing increase in the incidence of venereal disease. The danger to health of promiscuity must be spelled out loudly and clearly to young people.
So, coupled with the provision of facilities for family planning, which I support, we must ensure that there is good education and advice available. In no case is this more necessary than for the unmarried. We are supposed to be living in a permissive society. I want permissiveness to be cut short where it may affect the lives, future well-being and happiness of young people. By all means let us ensure that facilities are provided, but a lead must be given by the House as to how and in what circumstances those facilities are given.
I hope that in what I have said I have in some small way given a lead in this, because this is a moral issue as well as a medical and administrative one.
§ 4.56 p.m.
§ Mr. Edwin Brooks (Bebington)
My hon. Friend the Member for Berwick and East Lothian (Mr. Mackintosh) is to be congratulated on having sought successfully to raise this important subject in the House today. I believe that the House will join me in congratulating him, too, upon his admirable speech, which was masterly in its exposition of the facts and devastating in its critique of the Scottish Office's dilatory inactivity and obscure double-talk.
The time has come for those of us who have for some years been concerned about this problem to start calling a spade a spade. My hon. Friend referred to suggestions which have been made that we should not be seen to be pressing actively for Scotland to be included. I, too, have heard these suggestions and have been disposed to wait in the hope that in the fullness of time a sense of urgency will come into the Scottish Office. But we have been disappointed in successive years. I am beginning to wonder whether if we go on pursuing this policy of silence about what needs to 1759 be said and done, we shall, 40 years from now, still be in a Tannochbrae situation in Scotland.
It is not customary in the House for Members representing English constituencies, particularly those like myself, who had the good fortune to be born in Wales, to intervene in matters affecting Scotland. But my maternal grandfather was a Scot and I still have a residual interest in what happens north of the Border. I intervene in this debate not just to talk about Scotland, although I shall attempt to add to what my hon. Friend so excellently said, but because I believe that the Government's obscure policy towards Scotland is casting doubt upon the urgency with which they regard this problem throughout the Kingdom as a whole.
It is surely paradoxical—I think that there is an air of unreality about the debate—that we should be discussing, at a time when the mounting abortion rate is causing great anxiety throughout the country, the case for providing family planning services to those who wish to use them in Scotland. My hon. Friend described this as an open and shut case. The logic and the argument, however, seem to fall upon deaf ears.
This afternoon, perhaps for understandable reasons, the House is thinly attended. If we were discussing abortion in Scotland, many more Members would be present. Many more would be anxious to express their anxieties about this mounting social problem and often tragic personal problem. They would be saying, "If only we had an effective family planning service, we could avoid so much unnecessary human distress". This afternoon, however, we have the opportunity to talk about our priorities in this matter. Therefore, although I shall not detain the House long, I would like briefly to indicate my sense of disappointment—indeed, disillusion—at the way in which, so far, nothing has been done to activate the 1968 Act for Scotland.
In 1967, I was privileged to have the opportunity to introduce as a private Member the Bill which became the National Health Service (Family Planning) Act, 1967. As my hon. Friend has said, it was certainly my hope at that time that the Bill could have been so drawn up as to include Scotland, and, indeed, 1760 Northern Ireland, also. It is customary in this House, however, for this sort of matter to be handled separately for Scotland. That was the case with the 1946 and 1947 Health Service Acts, which applied to the two parts of the Kingdom consecutively. Certainly, I, and, I am sure, many of my colleagues at that time, from both sides of the House, were fairly confident that the time would come within 12 months when the powers then given to local authorities throughout England and Wales would be extended to Scotland.
It is true that during the debate, although my right hon. Friend the then Minister of Health expressed full Government support for the Measure, some of my hon. Friends—my hon. Friend the Member for Pontypool (Mr. Abse) and my hon. Friend the Member for Aberdeen, South (Mr. Dewar) for example—referred to their disquiet and their anxieties about the exclusion of Scotland from the provisions of the Bill. My hon. Friend the Member for Aberdeen, South, in particular, suspected that there might be forces within the Scottish Office which were actively hostile. A short time afterwards, however, when the 1968 Act was undergoing Second Reading, my hon. Friend, with his customary generosity, was the first to pay testimony to the recognition by the Scottish Office of the need for that Measure.
My hon. Friend said on 7th December, 1967:It is really extraordinarily encouraging to see this Clause. For too long the Scottish Office has been saddled with the notion—or people have saddled it with the notion—of being opposed to any kind of social progress and unwilling to touch controversial social matters. By introducing this Clause and presumably being instrumental in getting it included, the Scottish Office has gone a long way in throwing off that kind of slur—which has been a slur and misconception."—[OFFICIAL REPORT, 7th December, 1967; Vol. 755, c. 1782–3.]We all shared my hon. Friend's feeling that that was a welcome earnest of good intent on the part of the Scottish Office and we looked forward throughout the country to a rapid implementation of the Measure.
As far as I can trace, nothing was said during the Second Reading debate or in Committee on the Health Services and Public Health Act, 1968, as it became, to show that there would be any dilitory 1761 delaying tactic on the part of the Government. My hon. Friend the Under-Secretary of State, who will be replying to this debate, made it clear that the Government were sympathetic to the matter. He referred to this point on Second Reading on 7th December, 1967, and again in Committee on 8th February, 1968, when he elaborated at some length. My hon. Friend said thatWhen the Bill which related only to England and Wales was going through last year, it was made clear on behalf of my right hon. Friend the Secretary of State that if a similar Bill had been produced relating to Scotland he would have given it his general support.My hon. Friend went on to say:We have taken the first opportunity, as provided by this Bill, to bring Scotland into line with these provisions. The demand for this kind of provision in Scotland is as great as the demand south of the Border."—[OFFICIAL REPORT, Standing Committee D, 8th February, 1968; c. 246.]It really is strange, to put it mildly, that in the light of that observation about the existence of demand north of the Border, we should now hear it hinted that there is no evidence of any significant demand north of the Border. We cannot go on having this sort of contradictory information given to the House.
We have, as usual, to read the small print, and in Section 79 of the Health Services and Public Health Act, 1968 we find that the Act in its application to Scotlandshall come into force … on such date as the Secretary of State may by order so made appoint; and different dates may be appointed under this section for different provisions of this Act or for different purposes.It is under that power that my right hon. Friend the Secretary of State has delayed the activation of Clause 15 of the 1968 Act on the ground, as my hon. Friend has said, that the economic circumstances do not warrant giving this power to local authorities.
That argument will not hold water. These powers which would be given to local authorities are in any event voluntary powers. They are not powers which local authorities in England and Wales have so far been instructed to use. If they feel that on economic grounds they cannot implement these powers, even to the extent of 1 per cent. or 2 per cent. of the possibilities, presumably they will not implement them. That, however, is no 1762 argument for the Government saying that they have no right even to consider the opinion of implementing them. The argument which lays stress on the economic situation is quite spurious.
Not long ago, my right hon. Friend the Secretary of State for Social Services, whose mandate applies only to England and Wales, replied at Question Time to a series of questions on family planning. He indicated some anxiety about the slow implementation of the Family Planning Act in England and Wales, and he said:I share my hon. Friend's concern. It is very unfortunate that this new service was launched at a time of increasing financial stringency. Some local authorities seem much too inclined to regard the small sum they give to this work as being the first thing to dock when things are difficult, which is something I greatly deprecate."—[OFFICIAL REPORT, 14th April, 1969; Vol. 781, c. 788.]My right hon. Friend the Secretary of State for Social Services was there saying that it was quite wrong for local authorities to exercise parsimony in this matter and that it was something which he deprecated, yet, at the same time, his colleagues in the Cabinet and the Scottish Office were, apparently, quite prepared to dock it in the very first place and not give local authorities even the opportunity to spend this money. There is something very contradictory about all this.
When we look at the facts, which, in the long run, must surely dictate policy, we find cause for alarm. The general position concerning illegitimacy throughout the United Kingdom is bound to cause the House anxiety. In every year since 1959, expressed as a percentage of live births, the illegitimacy rate has gone up. It has gone up from 5.1 per cent. in 1959 to the provisional figure for 1968 of 8.5 per cent. Thus, one in twelve of all live births is now illegitimate. This is a trend which has continued throughout the 1960s despite the potential availability of more secure contraceptive devices such as the pill.
The figures for Scotland give no cause for complacency. In 1956, the rate for Scotland as a whole was 4.3 per cent. In 1961, it had risen to 4.6 per cent. By 1966, another five years later, it had risen to 6.4 per cent. In Glasgow, from 4.8 per cent. in 1956 it had risen by 1966 to 8.8 per cent. In the case of other Scottish cities, we find Dundee with a figure in 1763 1966, as high as 98 per thousand, Edinburg 82, and Aberdeen 75. Nearly all cities are on a raising trend.
It is true that as far as one can detect from the figures, the abortion rate in Scotland is somewhat below the rate for the United Kingdom as a whole, but during the period from 27th April, 1968, to the end of the year, 1,537 abortion operations were carried out in Scotland.
These are the ones we know about—and we can be quite certain that there are many, many more which are not recorded—and it is true also that Scottish women and girls come south of the Border to use the clinical facilities provided in London. The figures are difficult to disentangle, but figures have been supplied to the House which show that this does occur. I am not saying—it would be an over-simplification to say—that abortion would be abolished overnight if we had comprehensive family planning services with domiciliary facilities and so on, but I would have thought it fairly evident that a substantial inroad would be made into the abortion rate if there were such comprehensive family planning service available.
In conclusion—and I must apologise for having detained the House—
§ Mr. Simon Mahon (Bootle)
Is my hon. Friend certain that, with a greater provision of family planning services, the abortion rate in this country would go down? Is he absolutely certain?
§ Mr. Brooks
If my hon. Friend presses me to say whether I am absolutely certain, I say "Yes" to him. It seems to me that there are bound to be a proportion of pregnancies and abortions which arise because of inadequate knowledge of, and facilities for, family planning.
It seems quite evident that this is so. If there were facilities available to provide accurate and up to date information there would surely be a significant fall in the abortion rate. Let us not forget that in the wider community there is still a lot of ignorance on this subject. I express a personal view in saying that I think there would be a reduction in the abortion rate, but I suspect that it is a view shared by a majority of people. One can say that there is absolutely no evidence to the contrary, and common- 1764 sense surely dictates that what I have said is, in substance, true.
However, my final point concerns the economic excuse. My hon. Friend the Member for Berwick and East Lothian has already said enough to dispose of the argument that there will be savings in taking no action. Just over a year ago the Director of the Family Planning Association produced a detailed, comprehensive, cost-benefit analysis of the family planning service for the country as a whole. Of course, the figures he gave for individuals apply equally to Scotland as to England and Wales. We do forget what costs are involved in bringing into the world children who are unwanted, who are illegitimate, who may spend their lives in institutions, and which will certainly be saddled with more than their fair share of life's problems.
Maternity grant is £22 per child, maternity allowance £81 per child, welfare milk £7 per child, hospitalisation, £60 per child, health visitor, midwife, etcetera, £20 per child. This works out at about £200 per year per child. The estimate by Caspar Brook of this cost is a total of about £32½ million. Probably an equal amount is involved in delinquency, police action connected with delinquency, and so on. Then there are the costs of education. These are some of the orders of magnitude of the costs involved, and amount to about £100 million a year of expenditure by the community in the care and upbringing of children who are not planned and who are often not wanted, unfortunately, by their parents. There are about 70,000 children a year now who are born illegitimate, and then there are the so-called shotgun babies—90,000 a year, according to my figures.
We must, therefore, realise that the provision of family planning services is not less urgent in Scotland than in England and Wales. In conclusion, I would urge my hon. Friend the Under-Secretary, because I know that all his instincts are with us on this, to stop this equivocation, and to say quite clearly that, after three years, it is time to bring Scotland into line with England and Wales, and to make available the provision of a service which, I am convinced, apart from whatever economic argument there may be, would go far to minimise the social tragedy and the personal costs 1765 and misery involved in abortion and the of other hidden costs of the unplanned and unwanted child.
§ 5.15 p.m.
§ The Under-Secretary of State for Scotland (Mr. Bruce Millan)
I think the first point I would make in answer to this short debate is that I think all hon. Gentlemen who have spoken have perhaps not sufficiently drawn the distinction between family planning being made available on the National Health Service on medical grounds and family planning being made available on social grounds, and what we have been talking about this afternoon is the second question I have just mentioned. I think it is true to say that the speech of my hon. Friend the Member for Berwick and East Lothian (Mr. Mackintosh) rather gave the impression that there was absolutely nothing being done in Scotland by local authorities on family planning. Now that is in fact not an accurate statement of the position at all, as I shall show in just a minute or two.
However, I should right away make clear that there is absolutely no question at all of the Secretary of State for Scotland taking about family planning a view which is against its development. That is not the situation. It never has been the situation, and it is not the situation now. Perhaps I may be allowed to quote one or two extracts from the circular which the Secretary of State sent out—No. 10 of 1966—on 1st June, 1966, to the local authorities asking them at that time to plan for the future development of their family planning services. This is what he had to say, and this is how the circular started:The Secretary of State has had under consideration the present and future development of family planning services, which in his view can make an important contribution to family welfare. Planned parenthood strengthens family life; lack of planning, often due to ignorance of effective methods of contraception, may lead to marital disharmony, ill health and social breakdown.That was the view of my right hon. Friend and myself at that time, and is now. It was drawn to the attention of the local authorities, and, of course, at that time it was in the context of family planning services being made available on medical grounds.
Particular point was made and emphasis laid on, for example, what was 1766 said by the hon. Gentleman the Member for North Angus and Mearns (Mr. Buchanan-Smith) about the need for education in family planning matters. For example, we said:General education in family planning is a most important part of health education. It should feature in courses of talks or discussions arranged with parents' groups, mothers in clinics, etc., in general publicity; and not least in the day-by-day educational activities of health visitors, midwives, social workers and others in their visits to homes, provided they have no reason to believe that advice on the subject would be unwelcome. In all these ways help can be given in creating a stable and healthy family life.It is necessary to put these remarks on the record, because there was an indication in some of the remarks which have been made in this debate that the Secretary of State was against family planning in principle; in one speech there was even the suggestion that the Scottish Office had prevented local authorities from doing anything at all in the field of family planning.
Following on the circular, we asked local authorities in Scotland to give us returns of what they were doing in the field of family planning, and the present situation is something like this. I make this clear, that all along in this context I am talking of family planning on medical grounds rather than on social grounds, and I am not by any means trying to belittle or reduce in any way the important distinction we are drawing here. The position in November, 1967—and I imagine that the position has improved since—was something like this, that 37 of the 55 local health authority areas had family planning services available in their areas. In most cases services were provided by way of the agency of the Family Planning Association, but seven authorities provided services themselves. That left 18 areas where services were not available at that time. Three of the authorities were arranging with the Family Planning Association for services to be provided. The remainder of the authorities were mainly in sparsely populated counties, and several mentioned the availability of services in the areas of neighbouring authorities. Others—and again this referred to the sparsely populated counties—referred to the availability of services provided by general practitioners. That was the situation in November, 1967, and I have reason to believe 1767 that in terms of the availability of services the position will have improved a good deal since then.
Although I have not more up-to-date information on a completely systematic basis, it was then the position that most local authorities either spent money directly or assisted voluntary bodies providing family planning services. Usually this was the Family Planning Association, but one authority mentioned a Catholic birth regulation clinic, and another a local women's advisory association.
Most financial assistance took the form of cash grants, sometimes per capita payments, and sometimes premises for clinics were made available free of charge. At that time in Glasgow there were four clinics, three of them in local authority premises, and the Corporation made a contribution towards the expenditure of the Family Planning Association. It is necessary to put on record all these facts; otherwise the impression might be created that absolutely nothing is happening in family planning in Scotland.
We are concerned today with the extension of the services which are at present available from services on medical grounds to services on social grounds. I would not accept as completely accurate the account given by my hon. Friend the Member for Berwick and East Lothian about the preliminaries to the introduction of Section 15 of the Health Services and Public Health Act 1968. That was Government legislation, and there was at that time no question of the Secretary of State being coerced, or having to be persuaded, to introduce this Clause in the 1968 Bill. Our intention, which was made clear when the Bill of my hon. Friend the Member for Bebington (Mr. Brooks) was going through, was that at the first convenient opportunity we would introduce a similar provision for Scotland, and this was done in the Health Services and Public Health Act, 1968.
We are not arguing here about the desirability of making these services available in Scotland. I take the view that it is desirable that these services should be made available in Scotland, and so do the Government. Had it not been the Government's view, the provision would no thave been included in the 1968 Act.
1768 All that we are discussing this afternoon—and I am not saying that this is not an important consideration—is the timing of the implementation of this provision. Again, the impression has been given in public discussion in Scotland that this provision of the 1968 Act has been singled out for deferment. I am not laying any blame on anyone for this. This is not so. Several provisions in the 1968 Act which would have involved local authorities in additional expenditure have been deferred, the two which I want to mention on a United Kingdom basis.
For example, Section 13 of the Act, which converts the power of local authorities to provide home help services into a duty, has similarly not been brought into operation. I imagine that all hon. Members who are here this afternoon would think it very important that the local authority should be given the duty of providing home help services as soon as possible. But that Section, as well as Section 15 which is our immediate concern in this debate, has been deferred.
§ Mr. Mackintosh
The Under-Secretary is putting his finger on the point when he says that certain Sections have been deferred on economic grounds on a United Kingdom basis. What is puzzling is why one Section which has been deferred on economic grounds in Scotland has been implemented in early legislation in England. Why is there is difference between Scotland and England on family planning?
§ Mr. Millan
I will come to that in a moment. The point which I am making here is that a decision was taken on the 1968 Act that certain Sections of that Act which involved local authorities in additional expenditure would be deferred. It is unfortunate for Scotland that the timing of the respective pieces of legislation should have been as it is, but I shall say a little about that from the local authority point of view in a moment.
This Section has not been singled out for deferment. Other Sections in the same legislation which involved local authorities in additional expenditure have also been deferred. I have mentioned the home help service, and I should also mention Section 45 which gives local authorities a general power to promote the welfare of the elderly, and which I should very much like to see implemented 1769 as soon as possible, as would local authorities. But these provisions, because they involve additional expenditure, have been deferred.
I accept that the amount of money likely to be involved in the implementation of this family planning provision would possibly be quite small. We are at present asking local authorities to curb expenditure in other directions, and there is a feeling of resentment in some local authorities that the Government should ask them to curb expenditure and at the same time put additional responsibilities on their shoulders. There is a lack of logic in asking local authorities on the one hand to curb expenditure, and on the other hand, to put additional responsibilities upon them, and that is why we have felt that this provision should not be implemented in Scotland.
§ Mr. Simon Mahon
Does not my hon. Friend agree that the provision of extra home help services in places like Glasgow and Liverpool is very much more important than the extension of family planning?
§ Mr. Millan
I would not like to separate these provisions and to say that one is more important than another. When we are asking local authorities to keep expenditure within reasonable limits, we must sometimes prevent them from doing things which in other circumstances they would be very happy to do. We have to be sure of what we are doing before we ask them to take on additional commitments.
§ Mr. Brooks
Does not my hon. Friend agree that, to the extent that the powers which the Act gives to local authorities are to be implemented solely at the discretion of local authorities, there is no reason for local authorities to feel bound to spend money if they consider that there are higher priorities?
§ Mr. Millan
There is validity in that, but I must maintain the general point that during the last few months it has not been easy to place additional responsibility, whether discretionary or not, on local authorities.
§ Mr. Ian MacArthur (Perth and East Perthshire)
I have the greatest sympathy with the point which the hon. Gentleman is making about the financial problem and 1770 the restrictions placed upon expenditure by local authorities. The Minister appears to be advancing his argument in a selective manner. He paid little heed to it when we called some attention to the matter in relation to implementation of the Social Work (Scotland) Act, which will put a heavy financial load on local authorities. It is extraordinary to hear the Minister now advancing this argument when last night he supported a Bill which will place an additional financial burden of over £200,000 on Glasgow and Edinburgh in relation to fee-paying schools.
I doubt whether it would be in order for me to debate once again the matter of fee-paying schools. I have stated the general position in regard to asking local authorities to take on additional commitments.
There were a number of other points upon which I should like to make one or two comments, since some of them are very important. I consider the present illegitimacy rates to be a matter of great concern. I ought to point out that the trends in Scotland are matched by the trends in England and Wales. There is not much evidence at the moment that the slightly different statutory position in Scotland from the point of view of family planning is making any appreciable difference to the figures.
The provision of family planning services, taken by itself, is obviously a matter which ought to have an effect on illegitimacy rates. Unfortunately the whole question of illegitimacy is a much more profound problem than simply a matter of considering the extent of family planning and the availability of family planning advice and appliances. As my hon. Friend the Member for Bebington said, unfortunately the illegitimacy rates have gone up in the United Kingdom as a whole over a period during which, whatever may have been the legislative position, advice on family planning and the availability of family planning services have continued to expand considerably.
§ Mr. Brooks
Is my hon. Friend aware, however, that the percentage increase between 1967 and 1968 is the smallest annual percentage increase in any year in the 1960s?
§ Mr. Millan
I very much hope that that trend will continue in regard to England and Wales. The long-term trend, as my hon. Friend knows, has been upward, and at present the English and Welsh rates are still substantially higher than the Scottish rates.
I am sorry to say that there is not very much evidence in the Scottish context that the extent of family planning services available in different parts of Scotland, comparing one area with the other, produces very substantial effects upon illegitimacy rates.
Nevertheless, I take the point which was made. The illegitimacy rates are a worrying factor and we must all be concerned, whether through the extension of family planning advice and facilities or the provision of whatever other methods are available, to see that the rates are reduced.
This is also true of the abortion rates. It is too early in the operation of the 1968 Abortion Act to say that the figures in Scotland have shown a considerable increase. They have certainly increased in the current year to a level which is a little higher than they were running in 1968. It is too soon to say that there is any real sign in Scotland that the figures will continue to increase.
The situation seems to be that they are flattening out at the level at which they were running in the earlier part of this year. But these again are figures which we would very much like to see reduced. I speak as one who personally supported the Abortion Act, and I think that in general its effect in Scotland has been a very good one.
I should like to say, in conclusion, that there is no difference in principle between my hon. Friends and hon. Gentlemen opposite and myself on the desirability of bringing into operation this particular provision of the 1968 Act. We are thinking here simply of the question of the timing of its implimentation. As my right hon. Friend the Secretary of State said in the Scottish Grand Committee the other day, none of the local authorities has asked for this provision to be put into operation realising that the present position is purely temporary and is being kept under review. I hope that it will not be very much longer before we are able to bring this provision into effect.
§ Mr. Deputy Speaker (Mr. Harry Gourlay)
Before we take the next subject, may I remind the House of the scope of debate. Any questions on administrative policy may be raised which are implied or which have been covered by the grant of Supply, but questions of taxation and legislation cannot be raised.