§ Order for Second Reading read.
§ 1.17 p.m.
§ Sir Myer Galpern (Glasgow, Shettleston)
I beg to move, That the Bill be now read a Second time.
As hon. Members know, a back bencher faced with the formidable task of introducing and, if lucky, piloting a Private Member's Bill through its various stages has to rely entirely on his own resources and endeavour. Not for him the essential help of the legal draftsman, the expert research and guidance of the civil servant, and all the other aids available to the Government in promoting legislation. The consequence, all too often, is the presentation of a Bill which, had Government aid been made available, would in all probability have seen the light of day in a form more acceptable to the House.
I freely confess that this would have been the case with my Bill, which seeks to re-enact the Second World War temporary powers conferred by Defence Regulation 33B to compel the medical examination and treatment of persons suspected of suffering from venereal disease.
However, one may view the Bill, all of us must admit to grave concern over the fact that V.D. has now reached epidemic proportions in this country. The time has come when we must shock people out of their complacency, ignorance and apathy. In my opinion, this is a task not to be shirked by politicians. It is our duty to reveal the facts and proclaim human decency throughout society.
I believe that we have acquiesced for too long in permissiveness in moral issues and stood by while moral values are allowed to rot. A generation is emerging which no longer cherishes chastity. The present teenage culture despises the value of adult experience and authority.
The tragedy is that promiscuity among young people is closely connected with the step rise in venereal disease—notably gonorrhoea. The advent of the Pill and legal abortion will undoubtedly lead to still further promiscuity.
In Great Britain at the present time about 30 diseases are notifiable, for the obvious purpose of safeguarding the 945 health of the community. Yet venereal disease, which today constitutes Britain's second largest group of reported infectious diseases after measles, is not notifiable.
The facts are really startling. Every day in Great Britain 200 people contract a venereal disease. Last year the incidence of gonorrhoea rose by 15 per cent., and this year it is estimated that no fewer than 200,000 people will visit the 230 V.D. clinics in the country, in other words, one out of every 300 people in the country.
I invite the House to allow me to look in a little more detail at the statistics relating to the steep rise in the incidence of the disease. I quote from Appendix C, "Tables relating to cases seen at Venereal Disease Clinics: England and Wales" in the 1967 Report of the Medical Officer of Health. In 1950 the total number of males seen at V.D. clinics in England and Wales was 78,487. In 1967 the number had risen to 119,545. In 1950 the number of females seen at the clinics was 32,342. In 1967 that number had leapt to 56,829.
But those figures do not give the whole story. Britain's V.D. clinics report their statistics to the Ministry of Social Security, the erstwhile Ministry of Health, but these clinics serve only about three-quarters of the population. Specialists, general practitioners, and Service medical officers do not have to notify V.D. figures, and the Venereologists Group of the British Medical Association estimates that 25 per cent. could be added to the reported cases of syphilis and 15 per cent. to the figures for gonorrhoea for cases treated outside the clinic service.
The epidemic is, of course, not confined to Great Britain. The World Health Organisation experts on gonoccocal infection estimated in 1962 that about 60 million to 65 million cases of gonoccocal infection occurred annually throughout the world. The figures clearly establish the magnitude of the social problem confronting us today. Only 10 years ago doctors claimed that V.D. had reached a record low level. Since then, unfortunately, the yearly total of new cases has trebled.
The changing sexual behaviour pattern of young people, teenage promiscuity especially among females, is directly responsible for a considerable proportion of 946 the increase. Dr. Willcox of St. Mary's Hospital, Paddington, says:The very promiscuous are almost certain to contract veneral disease sooner or later.Intensified population movements by air, land and sea are also contributory factors to the rise.
I am most concerned, as I am sure all hon. Members are, about the steep rise in the incidence of venereal disease among the 15 to 24 age group. In 1963, 14,032 in this age group were attending clinics in England and Wales. In 1967 the figure for that age group had risen to 17,890, an increase of almost 33⅓ per cent. This prevalence of V.D. among young adults contract syphilis or turbing.
Unfortunately, there is appalling ignorance about V.D., particularly among teenagers, largely due to a considerable unwillingness and resistance to include V.D. in health education, the subject being regarded as dirty. In a survey recently undertaken, 1,800 teenagers were invited to write down something about their sexual knowledge. More than half knew nothing about the symptoms of V.D., and of those who confessed to sexual intercourse, three out of four boys and four out of five girls would never have known that they had become infected; yet National Health figures show that every day 50 teenagers and young adults contract syphilis or gonorrhea.
I dare say some hon. Members saw the Panorama programme screened by the B.B.C. a few weeks ago when it dealt with this very topic of V.D. It was an extremely interesting programme. Two medical men on the programme did not agree. One favoured the present situation; the other was all for legal action to try to control the disease.
I was most interested in the replies given by several of the teenage girls who were interviewed. On said:I cannot feel guilty or ashamed about having gonorrhea because I have done something completely natural like just to sleep with somebody. I just cannot feel ashamed.Another girl, asked whether she was ashamed when told that she had gonorrhea for the first time, replied:No, I do not think so.947 Yet another teenager of 16 said:I would not be horrified because it is quite a common thing nowadays.Teenagers and adults do not know that V.D. can be disastrous. In the light of those figures and in the light of the present situation, what are we to do? What guidance are we to give? What action are we to take in an attempt to control this scourge?
In the 1966 Annual Report the Chief Medical Officer of the Ministry of Health, as it was, said:These infections are human problems with potentially disastrous effects on health and happiness. If they are to be contained they require high standards of skill, devotion and energy from clinicians, epidemiologists and auxiliary workers. They require also from the public more knowledge and more under-Standing of human frailty unclouded by prejudice.What does that declaration mean in practical terms? Despite the rising figures, only one new clinic attached to the Middlesex Hospital has been built in the last 25 years. There is no money available for the propaganda that is so urgently necessary. One venereologist declared:We come right down at the bottom of the list for money because the people who allocate it are still the ones who believe that those who get V.D. deserve to suffer a bit.I do not know how far this is fair criticism. The Under-Secretary of State for Health and Social Security said, in a Written Answer on 18th November, 1968:The Government take the problem of venereal disease very seriously, and steps are currently being taken to improve the tracing of contacts, which I consider is the most effective way of controlling these diseases. There is also need to increase public awareness about these infections, and I am sure the newly formed Health Education Council will play an important part in this."—[OFFICIAL REPORT, 18th November 1968; Vol. 773, c. 209.]Let us consider contact tracing, the method favoured by the Secretary of State. In November, 1968, the then Minister of Health sent to local authorities a memorandum headed "Contact Tracing in the Control of Venereal Disease." I should like, if it would not bore the House, to have the opportunity of reading practically the whole of this document because it is a very fundamental document to this debate, but I shall restrict my quotations to certain aspects of it.
I begin with paragraph 6, "Aim of contact tracing", because it is essential that 948 the House should know precisely what is involved in contact tracing and should see whether this is a method which can be relied upon reasonably to control the spread of V.D. That paragraph says:The aim of contact tracing is to ensure that the sexual contacts of persons found to be suffering from venereal disease are identified and persuaded to attend a clinic for examination and for treatment when this is necessary. This is not only in the interests of the individual; it is the most important single preventive measure that can be taken in attempting to control these diseases. Contacts may include not only the presumptive source of infection of a particular patient, but others with whom he or she may have associated in a promiscuous group. They may also include a spouse who is unaware that infection has occurred.Paragraph 7 is headed, "Necessary conditions and Action". It says:Contact tracing calls for a cycle of action as follows. The patient provides information to an 'interviewer', who either acts on this information or conveys it to a 'contact tracer'; subsequent action by either is to seek out the contact and persuade him or her to obtain medical advice. If this person is infected a further cycle will then begin; the first cycle should be completed by reporting the outcome to the clinic which got the information first.Paragraph 8 says:If efficiency is to be ensured, the following conditions must be satisfied. The utmost speed"—those words are in bold capitals—in obtaining, communicating and acting upon information must be achieved…".I doubt whether what I have read so far is indicative of how it will be possible to act with speed in tracing somebody, whether by the colour of his hair, or his complexion, or his size, or anything else about that person, for the paragraph goes on to say:…but at the same time, confidentiality between the patient and doctor must be honoured.I come to the final paragraph, paragraph 10, which is important:Interviewing the patient.At present the patients usually give information regarding their sexual contacts either to the clinician or to another 'interviewer', who may be a member of the nursing staff, a medical social worker or other officer employed by the hospital, or an employee of the local health authority working at the clinic. On the first occasion patients are often given one or more contact slips and asked to persuade their sexual contacts to attend an appropriate clinic with the slips. This method, which meets with a reasonable 949 measure of success where the contacts are regular consorts but with very little success where contacts are casual, will continue to be useful; and it must be left to the judgment of the 'interviewer' whether it is to be employed in individual cases. Consideration should be given, however, to the use in every possible case of a more active tracing method, in which identifying details concerning the contacts are diligently sought, as well as or in preference to the contact slip.I have read from that report in some detail to try to give hon. Members the opportunity of judging the type of work involved in this method to which the Secretary of State pins his faith.
I have tried to put the success of contact tracing to the test by reference to statistics, and I shall simply quote what I thought would be the most acceptable figures from the annual report of the Glasgow Medical Officer of Health, published in 1967 Table VII in that report shows the outcome of efforts to trace female contacts. The total number notified at local clinics and elsewhere was 1,145 in 1967. The number not traced was 722. In other words, roughly 60 per cent. of the people suspected as possible contacts have not been traced by the social workers involved. I believe that this is probably indictave of the pattern throughout the country.
A good deal of pioneering work in this field has been done in Sheffield, but I have not been able to obtain any figures which would allow me to reach a conclusion on the extent of the success of this system of contact tracing in Sheffield.
I am sure we are all serious in our desire to control venereal disease, and I believe the issue before the House is whether we should have contact tracing or compulsory notification and treatment, as I have suggested in the Bill. Before we proceed to arrive at a conclusion, let us consider how other countries deal with the problem. Forty-four countries have varying forms of venereal disease legislation which, in the majority of cases, is based on the Swedish law of 1918, as amended in 1948. This law makes treatment compulsory for all patients and requires medical practitioners to trace the source of infection. Infecting, or exposing another to infection, is made an offence. In Great Britain, medical practitioners are not required to notify cases and there is not compulsory examination and treatment.
950 Let us look for a moment at legislation in some other countries. As I said, I do not regard the Bill as perfect and, if it were given a Second Reading, I should have no objection if it were then mutilated in Committee and we were able to draw upon other sources of knowledge in order to produce a worth-while and workable Measure.
In Italy, all cases of venereal disease with active contagious manifestations must be notified to the provincial medical officer. In Canada, when any physician or other person attending any patient knows or has good reason to believe that such a patient is infected with venereal disease, such physician or other person shall take action with regard to notifying these diseases as is provided for by the special regulations regarding venereal disease issued by the Minister of Public Health, and it shall be the duty of every physician immediately upon discovering a case of communicable disease to secure the isolation of the patient or to take such action as is required by the special rules and regulations laid down.
In East Germany, the onus is laid upon the person. Any person who knows or suspects that he is suffering from a venereal disease must immediately have himself examined by a physician and, in case of disease, submit to treatment as well as to the necessary subsequent examinations or treatment. Examination and treatment, in the contagious stage, shall be regarded as complete when a written medical certificate to that effect is issued. East Germany goes still further: if the patient or suspect is a minor, or if he is incapable of appreciating the necessity and significance of the medical measures and the danger of contagion, a guardian or other person responsible for his well-being must be informed.
In New Zealand, the position is much the same. Persons suffering from venereal disease are by law required to undergo treatment.
In France, any person with respect to whom there exists definite, serious and concordant circumstantial evidence to the effect that he has communicated venereal disease to one or more persons may be required by duly substantiated decision of the health authorities to present within a time limit set by those health authorities a medical certificate stating that he 951 is, or is not, suffering from infectious venereal disease.
If my argument so far in favour of compulsory notification has not met with much success, perhaps the thought that to adopt it might enable us to enter the Common Market with less difficulty and greater expedition may influence hon. Members to agree that our law should be changed and be brought more into accord with that now effective in France.
I am not suggesting that these other countries have been 100 per cent. successful in treating cases as a result of their legislation on venereal disease. Obviously not. But I submit that their approach is preferable to, and more successful than, ours. The system of contact tracing is laborious and difficult, for the social worker has very little information to go on. If hon. Members will read the whole of the memorandum from which I quoted extracts, they will see precisely and in detail how frustrating the business of contact tracing can be for the people engaged in it.
I do not regard the purpose of the Bill as an infringement of civil liberties, as some organisations have seen fit to say in letters to me. Are our requirements for the notification of infectious diseases, almost 30 of them, an interference with civil liberty? Would there not be a public outcry if those requirements for compulsory notification and isolation were repealed? I cannot, therefore, accept that argument. In some public places people are prohibited from smoking. They do not regard it as an interference with their civil liberties. There are many restrictions of that kind, but they are not in a true sense interferences with or restrictions upon the rights of individuals.
In reply to Questions recently, the Secretary of State for Social Services said that the expenditure on venereal disease cannot be ascertained. Undoubtedly, a large sum of money is required here. We do not know how much is being spent, but we do know that a substantial sum is needed on three important aspects of the problem—health education, the establishment of more clinics, and research.
There is a tremendous amount of work to be done in health education. There are few indications in places to which people go of what to do if one contracts 952 a venereal disease, except in some old Underground toilet rooms. We never see on the Underground or the escalators along with the other advertisements notices telling people about treatment or about what to do. A lot of propaganda ought to be done in health education. There is a lot of resistance to be overcome, and overcome it will have to be. There is a lot to be done in the establishment of more clinics and in research. One venereologist told me that if he could have £50,000 he could do an enormous amount of work on V.D. infection.
The fields I have mentioned—health education, the establishment of more clinics, and research—are basic to any campaign for the control of venereal disease, but they are ancillary to and not substitutes for compulsory notification and treatment. In my opinion, Defence Regulation 33B was a successful measure in the fight against V.D. I regret that it was repealed. I am convinced that contact tracing will not meet the present urgent need for the control of venereal disease in view of the alarming increase in its incidence. I urge the House to give the Bill a Second Reading.
§ 1.48 p.m.
§ Mr. Charles Pannell (Leeds, West)
My hon. Friend the Member for Glasgow, Shettleston (Sir M. Galpern) has had a distinguished record in local government in Scotland. Few hon. Members could claim to have held a position like that of Lord Provost of one of our two great cities. One remembers with respect an hon. Gentleman opposite, a great friend of mine, Sir Will Darling, who will have been known also to my hon. Friend.
In taking on this Bill, my hon. Friend has taken on a task which should rest squarely on the Government, not on the private Member. All my experience is that Bills of this sort and this length stand little chance of passing through the House at this time of year. If we are forced to a vote on the Bill, I shall not vote against it, but I do not think that I shall vote for it.
I spoke of local government a moment ago. The Association of Municipal Corporations, of which I am a vice-president, takes a very dim view of the Bill. It thinks that it is one of those Bills which, under the guise of being helpful, is positively dangerous.
953 I welcome any steps towards limiting the spread of venereal disease, but the Association's Health Committee is opposed to the principles of the Bill because it considers that compulsory medical treatment is unsound in concept, and that the provisions are not likely to be an effective measure of controlling the spread of the disease. A compulsory system is a right-about-turn from the practice of the past 50 years in dealing with this social danger. There was a Royal Commission on the matter. The Bill might well discourage people from attending for treatment. Social workers have, in general, been very successful in persuading contacts to attend for medical examination, and it would be harmful to this voluntary relationship if it became known that information given to a social worker or doctor could lead in due course to the legal action.
One is always rather diffident about opposing Measures such as this, but it must be said that venereal disease is one of those hit-or-miss diseases. It largely springs from promiscuity. It might be perfectly possible for a person not suffering from it to sleep with someone for a night and to be reported upon. There might be a leak in the legal machinery and the information might reach his or her place of work, and the matter might end with litigation. I do not like the idea of being prepared to accept a statement from an injured person, someone who suddenly finds himself or herself with the disease and says, "I think that it was So-and-So." He or she might be promiscuous. That idea is a bit grim.
My hon. Friend spoke about the example of 44 other countries. But, it is not enough to do that. One must look at their social backgrounds. My hon. Friend mentioned East Germany. I have been there, and I know that the docketing of people for all sorts of things is rampant. That has not been the practice here.
When I am in doubt about a matter, I always like to look at the history of previous attempts at legislation on it. I am glad to see my right hon. Friend the Member for Sowerby (Mr. Houghton) here, because, like me, he has always been interested in movements for women's rights. One of the greatest Parliamentary battles of all time was fought over the Contagious Diseases 954 Acts and associated with it was the greatest of all women in this field, Josephine Butler. Because soldiers caught diseases in garrison towns, in the 1840s there was legislation that any women in a garrison town or seaport who refused to submit to medical examination for venereal disease should be labelled as a common prostitute. A famous by-election was fought in Colchester on the issue. It was the first time that women had really entered into the electoral battle. The owners of the brothels in Colchester were so upset about this that they burned the building in which she spoke, and she had to flee from the crowds. In those days, Ministers had to fight an election when they were appointed, and Sir Henry Storks was killed politically in that by-election.
That resulted in the great Royal Commission on the Contagious Diseases Acts. One can read its proceedings in the Library, and it is still interesting to read those old pages. Josephine Butler was the first woman ever to appear before a Royal Commission. The Commission obviously thought it had a timid woman before it, but by the time she had answered her eleven hundredth question she was dominating the proceedings, and a contemporary document said:It seemed that the spirit of the Lord had entered there.The women's movements have fought all along against compulsory registration, and they will not accept this Bill. We still have a dual code in our society, that women must be punished and conditioned to the needs of men. This is very much resented by women. I opposed the Street Offences Act and all similar legislation because of that dual code, and I shall also oppose the one before us. I do not mind legislation that fixes upon people known to have a contagious disease, but I am opposed to the kind of snooping that can lead to blackmail, the vilest of practices, and which may involve an innocent person.
We must draw a sharp line between crimes that outrage the law and matters of morality. There used to be a strongly held doctrine that young people should not be fitted up with contraceptives because they might become immoral. I am rather old-fashioned, but we see that practically every university now gives advice on contraception to protect the 955 innocent, the ignorant and the inexperienced, and it may be extended to grammar schools.
The House cannot accept the system laid down in Clause 1. I would not be guided by what other countries do. I am a child of this House and this country, and I know how the political system has grown up. I know the great battle fought by the women's organisations, and it is the women who will be the principal victims of the Bill. It will not be the men. I know the great Parliamentary battles that have been waged over the years to protect women against the dual standards that men still observe.
The Armed Forces can look after their own affairs; we are speaking now of civilians. I think that we shall have to return to the idea of as much education as possible, which will probably have to begin at a lower age level, in the schools. When cases of V.D. are found, we shall have to bring great pressure to bear on those known to have it. But that pressure will not extend to the idea of their being informers on the person with whom they might have slept the previous night. One reads in the papers about people sleeping round.
§ Sir M. Galpern
I remind my right hon. Friend that the clinic system involves informers, because the person who comes to the clinic has to tell the social workers where to look for the other person involved.
§ Mr. Pannell
I have had a great deal to do with social workers and have been chairman of committees of social workers. Generally speaking, they are trained in their work just as any other professional people are trained. They certainly know that confidentiality is the basis of their work.
§ Mr. Pannell
They are not informers any more than policemen are informers. Social workers are not informers. They may go to a social contact and say, "Will you go on this?". But that is very different from serving a notice which might go astray to an employer, for example. I expressed some doubts about the White Paper, "In Place of Strife", because of the attachment orders suggested. I know 956 how hit-and-miss affairs attachment orders are. It would be very unfriendly of me if I were to suggest that my hon. Friend has not brought this Bill forward with the best possible motives. But it was Ramsay MacDonald who said, "It is not consequences you have to worry about, but the consequences of the consequences…". The consequences here could be pretty grim.
The Bill would breach our history, particularly that of the women's movements—and women would be the principal sufferers—and would breach the basis of confidentiality. There are surely other ways to achieve what my hon. Friend wants and I must therefore end in the way that the Association of Municipal Corporations asks me to end—by expressing the point of view that it would be better if the Bill did not make any further progress.
The Government should consider legislation to deal with this great social evil in a far more comprehensive manner than is considered in the Bill. If my hon. Friend has stimulated the Government into that degree of activity, then his exercise will have been well worth the effort.
§ 2.2 p.m.
§ Mr. Ronald Bell (Buckinghamshire, South)
I owe the hon. Member for Glasgow, Shettleston (Sir M. Galpern), and the House, an apology for coming to speak without having heard his speech. It was only because he rose at the regrettably inconvenient hour of 1.15 p.m., and since the House does not adjourn for lunch inevitably some people interested in an item of business will be in the dining room when it starts. Furthermore, although I have to say that I do not agree to the Bill, I, too, take it for granted that he has promoted it with the best possible motives.
Like the right hon. Gentleman the Member for Leeds, West (Mr. C. Pannell), I cannot feel that the Bill should go through and become law and enforced. I understand that the right hon. Gentleman is particularly concerned with women and their organisations, but I think that this Bill could work all ways. There is nothing in it about confidentiality, and I do not think that there could be, because this kind of procedure is bound to 957 go through clerical and filing departments of local authorities. There would be no confidentiality about it at all. It would lay anyone open to the most appalling blackmail or even just malevolence—even to a practical joke. It would be a rather effective practical joke, though deplorable. We just cannot expose the citizen to this kind of thing.
The detriment which comes from venereal diseases is obvious and regrettable, but I do not think that we can do much about it by legislation, whether introduced by the Government or by a private Member. We can do a good deal about it by education and by administrative arrangements, but legislation will never play a major part in the campaign which must be waged against these diseases.
With the feeling that this Measure would be an incursion upon freedom and—even more than that—upon the personal safety and the reputation of the individual, I could not possibly endorse it. Even though I did not have the advantage of hearing the hon. Gentleman's speech, I am sure that there was nothing in it in favour of the Bill which could have changed my views.
§ Sir M. Galpern
I am sorry that the hon. and learned Gentleman was not here. I am sure that, had he listened to my speech, his decision would be the reverse of the one he has arrived at.
§ Mr. Bell
The hon. Gentleman flatters both himself and me by implying that he could have persuaded me and that I am so open minded that I would have been persuaded. But I do not think that I would have been persuaded, because I think that I understand the implications of the Bill. While I understand his motives, I also understand the machinery by which the Bill must inevitably operate, and that machinery could never be acceptable to me. To my regret, therefore, I must oppose the Bill.
§ 2.8 p.m.
§ Mr. Laurence Pavitt (Willesden, West)
One of the differences between the world as it was when I was a teenager and the world of today is that, in my day, we said, "Nothing succeeds like success", whereas it seems that in the world today nothing succeeds like sex. Running 958 throughout this debate there has been the tendency to look at teenagers as though they and not we made the world in which they find themselves. We discuss the Bill against the background of the whole accent given, in advertising, for example, to sex. One cannot go down the escalator in the underground without seeing that the whole accent is placed on sexual relationships, even if twice removed by way of underwear. It becomes difficult for us, in tackling an important subject like this, if we are immediately to opt out of the responsibility we have.
The House is grateful to my hon. Friend the Member for Glasgow, Shettleston (Sir M. Galpern) for giving it the opportunity to look at this extremely important matter. I am sure that my right hon. Friend the Member for Leeds, West (Mr. C. Pannell) spoke for all of us in saying that none of us doubts the aim my hon. Friend the Member for Shettleston has in mind and that we all share the hop that we shall be able to do something about it. Running throughout the debate is condemnation, contained in the suggestion that there has been a big increase in recent years in these diseases, whereas, as I think most right hon. and hon. Members know, this problem has been ever with us. Indeed, my hon. Friend said so. He said that it is ever topical.
This is also part of the problem when dealing with health matters in relation to venereal diseases, for one encounters attitudes with moral overtones, involving some judgment, whether Victorian or otherwise. All these are newsworthy and are able to get discussions, whereas in the rest of the health field some of the killers in our midst cannot get the same amount of attention.
My hon. Friend spoke of the difficulty of drafting legislation. Most of us who have had to tackle the problem share his view and it is time that the House helped hon. Members with their legislation. But, it may be some consolation to my hon. Friend that I got on to the Statute Book last year a Measure with no help in drafting. It took me three years, but I think that this Bill would take much longer than that.
My hon. Friend referred to a number of tables in the Report of the Chief Medical Officer of Health. Although he 959 was right to say that the problem was important and that in some areas it had increased, it would be wrong to ignore the fact that the tables for other areas show a decrease. Table C.3 on page 281 shows that the incidence of congenital syphilis dealt with for the first time fell from 1,223 in 1950 to 216 in 1967. Table C.2 and table C.4 show a decrease in the figures to which they relate. Mortality from congenital syphilis among live births decreased from .003 per 1,000, a very small figure in relation to the population, in 1912 to less than .001. I am not playing down the problem and we should not underestimate that there has been an increase in the difficulties, but it is important to get it into perspective.
§ Mr. C. Pannell
The global figures show a diminuation from the high figures during the war, but an upsurge in the last ten years.
§ Mr. Pavitt
That is so. Nevertheless, the curve flattens out. One of the most encouraging parts of the Report is that the curves for both gonorrhoea and syphilis flattened out from 1966 onwards. The figures for 1966 were more cheerful than those for 1965, while those for 1967 were more cheerful than those for 1966. There was a fairly consistent upsurge until 1965, but there is a little gleam of hope to be derived from the flattening-out of the curve since then.
I echo much of what was said by my right hon. Friend the Member for Leeds, West. The problem is to ascertain whether the Bill's designs will achieve the result which my hon. Friend the Member for Shettleston intends. We have had the experience of garrison towns when notification was compulsory and enforceable, but I am informed by my own local medical officer of health that experience then was infinitely less satisfactory than under the present voluntary system. Most medical officers of health will endorse that view.
It is one thing to have compulsion and quite another in an area as sensitive as this to stem the spread of venereal disease through contacts. I am aware of the work in hospitals of the North-West Metropolitan Regional Hospital Board and I am satisfied that its social worker approach in the last few years has been 960 highly successful. It is true that it becomes a kind of detective work, but trained social workers are able to deal with these delicate matters and are able to secure confidence and the kind of information required and to establish where the contacts are in a way which would not be possible with the provisions of Clause 1 with legal sanctions and all that that implies.
I agree with my hon. Friend the Member for Shettleston that there is an absolutely outdated approach to special clinics. One can go into hospitals within a stone's throw of this place, across the river and elsewhere, and walk down back corridors, to reach signs saying "Males" and "Females", rather like a public lavatory, but not so elegant. Notices advertising the treatment of venereal disease are to be found mainly in public lavatories. We still approach this matter with a kind of Victorian "Get thee behind me, Satan".
We do not give it the same approach which we adopt in other health matters, the kind of approach which we have achieved with mental health. There was a similar attitude to mental health some years ago. It was thought that it had to be shut away behind bleak walls. But in the last 20 years we have made mental health an ordinary health problem. We have brought it into the open. People are treated not only in mental but in general hospitals, and also remaining in the community. This has solved some of the difficulties of mental illness in the same way as with bodily illness. Venereal disease is another type of illness with which the community has to deal, and should deal with it in a far more open and forthright way.
One thing I commend teenagers and the younger generation for is that they have lost the kind of hypocrisy which many of us had in our younger days. They are prepared to look at these things openly when we regarded them as something furtive and secretive. My hon. Friend the Member for Shettleston made that apparent when he quoted some of the statements by young people caught up in this tragic disease. We have to keep it in proportion.
We have a tendency to imagine that all teenagers are somehow caught up in sex and drugs. There is an increase in venereal disease and an increase in 961 promiscuity. But last night I was heartened when I went to a prize-giving at Willesden College of Engineering and Technology. A hall was crammed with people and, as the principal was giving his report, I looked at the teenagers and thought of the popular headlines of the popular Press. But the principal reported that more than 1 million study hours were undertaken within the precincts last year. Every morning, about 1,600 students attended the college and evening classes had comparable numbers. One can go to the Royal Festival Hall to hear a Bach concert and find 3,000 youngsters, many of them teenagers. But those things do not get the headlines.
In our approach to venereal disease and how to deal with a problem which affects youngsters as it affects us, we have to keep the matter in proportion and not use phrases which are too emotive, such as, "In my young day, we did not do anything like that." In my young day, many things went on under-cover, things which these days are done far more openly and which are much more part of the scene. It may be because of that that there are more elderly fears about these things.
But the increase in the incidence of venereal disease cannot be ignored. There were 41,829 cases of gonorrhoea last year affecting 37,849 people. Gonorrhoea seems to be the most difficult problem that the medical profession had to tackle in the whole range of venereal diseases. But an analysis of the tables shows that only 15 per cent. of those affected were between the ages of 16 and 19, that is, 5,503, and nearly 20,000 people were over the age of 24. The statistics, therefore, do not show that this is a problem confined to teenagers.
I was interested in the comment of the Chief Medical Officer of Health that:It is satisfactory to note that the returns for 1967 show a further decline in cases of infectious syphilis indicating that the spread of this disease, which has proved so intractable in other countries, is being contained here".That is why I listened with interest to the account of the homework undertaken by my hon. Friend into what had happened in other countries. Although the disease is increasing in other countries, it is being contained here. The 962 Chief Medical Officer of Health went on to say:On the other hand, as will appear from the details which follow, gonorrhoea has shown a further sharp increase in both men and women and the prospect of an early solution seems to be remote.That is why I can understand my hon. Friend bringing forward the Bill in an attempt to find a solution which now seems remote.
§ Mr. C. Pannell
My hon. Friend the Member for Shettleston mentioned 44 other countries. I do not have his acquaintance with the figures, but over a long number of years those countries with notification has had curves going up similarly to ours, with a retraction from the last war and then an upsurge.
§ Mr. Pavitt
That is borne out by examination. The World Health Organisation has done extremely good work which bears out what my right hon. Friend says. However, as the Chief Medical Officer of Health has said, there has been a decline in the incidence of syphilis since then. The curve is flattening out and the evidence is that it can be contained, but the problem is that as fast as we defeat bacteria and viruses so they seem to put on extra "muscles" and we then have to find stronger drugs for stronger diseases.
A plea has been made today that we cannot spend too much on research in this problem. In the Annual Report, we get further information which is salutary in view of the fact that prostitution has now been driven from the streets of Piccadilly. On page 71, we read that of 102 prostitutes admitted to Holloway Prison in 1967 aged between 15 and 20, 61 submitted themselves to examination and 38 proved to have infection, three from syphilis and 35 from gonorrhoea. So it would seem that it is not only the social problem which must be solved, the promiscuity which might take place in all kinds of circumstances and places, but also the whole problem of prostitution. This is no doubt one of the sources which will have to be thoroughly tackled. I recognise that this goes beyond my hon. Friend's Department to the Home Office.
The House has been generally united about health education. We realise that perhaps the most constructive thing that we can do, whether or not the Bill goes 963 further, is to continue health education. I commend to the House the article of the noble Baroness Birk in this month's Nova, a magazine which is more likely to be read by teenagers than either The Times or The Guardian. On the front cover it has a picture of the bare-bottomed Beatle who got married yesterday; within, it has the other attributes which may attract young people, and there are four excellent pages on venereal diseases which young people will read.
One of the first articles that I have read for some time, about sense in sex, was in The Guardian on Wednesday by Catherine Storr. This was an amazing and very perceptive approach. I immediately wanted to cut it out and send it to my children, because that was the kind of thing that I wanted to tell them. But they are unlikely to appreciate it for it is written in my generation terms. They will easily read Nova, which is in the language that they understand.
Therefore, when my hon. Friend is considering education, I hope that he will not do so only in a narrow and academic way. This must spread. The aim of education is to communicate with those who one is trying to educate. Education is not for the educators but for those whom one is seeking to impress with ideas. In those circumstances, we must use the channels of communications which are acceptable to young people today, if it is the young people that we are trying to reach. Therefore, I commend Nova, which is a very with-it kind of magazine, and the way in which this media can provide an extension of understanding of important problems.
We still have to face the provision of research, and I shall be very surprised if the Medical Research Council is short of funds for venereal research. My hon. Friend quoted a venereologist who said that, if he had £50,000 more, he could do a tremendous job. But my experience in the fields in which the Medical Research Council operates convinces me that projects which have a fair chance of success are not kept short of funds. My hon. Friend will obviously deal with this, and I look forward to what he will say.
In the Chief Medical Officer's Report, we read: 964Non-gonococcal urethritis remains an intractable problem. The cause of it is unknown and the evidence that it is a transmissible infection is therefore based on epidemiological experience. But the evidence is very strong.In a case like this, when one knows the question but knows that doctors do not have the answer, a little pressure could be put on the Department of Education and Science for the Medical Research Council to advance special projects in this field.
Research for earlier diagnosis in gonorrhoea is essential. The problem with gonorrhoea is the very short incubation period when the infection shows no symptoms but when the disease can be imparted. A classical case is given in the Minister's Report, of the holiday camp where, in 1967, one case led to ten, but by the time the ten were traced, three had already disappeared.
In the rapidly changing social situation and with the gap between the generations, I came to the Bill with a fairly open mind, though with a leaning against it. After hearing the debate, I am convinced that this is not the way to get the results that my hon. Friend wants. The changing social pattern is extremely fluid and the way in which human relationships are developing is something with which we have difficulty in keeping pace. Things move almost as fast as my hon. Friend (Mr. David Ennals) moves from the Elephant and Castle to John Adam Street and back again to the Elephant and Castle.
Although we might applaud my hon. Friend today, I hope that the Bill will not be given a Second Reading, but that we shall hear something constructive from the Ministry about the way in which the things which have been mutually agreed across the House about education and research will be given an added fillip as a result of this discussion.
§ 2.27 p.m.
§ Mr. Antony Buck (Colchester)
The hon. Member for Glasgow, Shettleston (Sir M. Galpern) is always listened to with great attention in the House because of his distinguished service both to the House and to local government north of the Border, and he has done the House a service in bringing forward the very serious social problem of the diseases under the sordid heading of 965 "venereal disease". However, we on this side think that his suggested methods of dealing with some of these problems are not acceptable for a variety of reasons. One of the most cogent is that mentioned by my hon, and learned Friend the Member for Buckinghamshire, South (Mr. Ronald Bell)—the whole question of confidentiality.
There are other reasons which cause me to say that this method is not satisfactory. I do not find it acceptable, for instance, that a person who has contracted venereal disease should be encouraged to become an informer to the doctor about the person from whom he suspects he may have contracted it, when the end result could be criminal proceedings. Nor do I find it acceptable that the doctor should be put in a semi-judicial position. Clause 1 would put upon him some duty to assess, the reasonableness or otherwise of the patient's suggestion that it might have been a certain named person who gave him the disease. This puts the doctor in an invidious position, and must make a semi-judicial decision on evidence of the most unsatisfactory type—suspicions communicated to him in private.
Similarly, the medical officer of health would also be in an invidious position. By the terms of the Bill, he would have to assess the reasonableness or otherwise of the suspicions of two or more persons which might have been transmitted to him.
I do not find it acceptable that we should create a criminal offence in the circumstances set out in the Bill. I do not find it acceptable that it should be a criminal offence not to submit for examination or treatment. One foresees a legion of difficulties leading to blackmail, and so on, which could arise. To suggest that it should be a criminal offence punishable, under Clause 6, by a fine of up to £50 or imprisonment not exceeding two months if one has refused to submit to examination or treatment is not acceptable, especially when the offence which is created seems to be absolute. A demand could be made that a person should attend for examination in spite of the fact that there might be no evidence that he or she had a disease of any type. This is invidious. It seems to us, therefore, that the Bill offends against the principles of natural justice, and, in addition, is not acceptable on grounds of practicality.
966 The best method of approach to deal with the problems is in the way suggested by the hon. Member for Willesden, West (Mr. Pavitt). I know that the sponsor of the Bill accepts that the best way is to continue to ensure that there is ample health education concerning these matters and research on them. I hope today's debate will have contributed to the knowledge on these serious problems which have been put in perspective both by the sponsor of the Bill and by the hon. Member for Willesden, West, to whose speech we have listened with such interest.
§ The Minister of State, Department of Health and Social Security (Mr. David Ennals)
I would like to start by congratulating my hon. Friend the Member for Glasgow, Shettleston (Sir M. Galpern) on his initiative in bringing forward the Bill. He has heard a number of criticisms of it, and I shall emphasise some of them. The House, is however, indebted to him for having raised the problem in the way he has done. He has done a great deal of research and has spoken from a wealth of experience and background, which the House always appreciates.
My hon. Friend rightly said that we are dealing with a problem in which ignorance is, perhaps, one of the most significant factors. One of the main reasons why I am grateful to my hon. Friend for bringing forward the Bill is that the very debate and the points which have been brought out by hon. Members on both sides may help to dispel some of the ignorance by bringing the facts out into the open.
I want to start by considering the question of how serious the problems are and looking at some of the statistics which have been mentioned and, perhaps, adding some of my own. Certainly, venereal diseases have increased throughout the world in recent years. That is the situation not only in this country. But in Britain, there are relatively few cases of syphilis, and the numbers are tending to decline.
The numbers which I am about to give are of cases that were dealt with for the first time at clinics. In 1950, 5,979 males were treated for syphilis. The total fell to 2,401 in 1960. In 1966 it was 2,454, and it fell further to 2,434 in 1967. 967 In 1950 the number of females was 4,988, and it fell to as low as 1,169 in 1967. We can, therefore, see that there has been a dramatic decrease in syphilis in the early 1950s and subsequently a tendency to decrease more slowly.
My hon. Friend was quite right to point out that the cases of gonorrhoea have been increasing in number year by year during the late 1950s. They seemed to have stabilised in the 1960s, but in the last couple of years they have substantially risen. In 1950, 17,007 males were reported for treatment. The number rose to 26,618, in 1960, to 27,921 in 1966 and to 30,645 in 1967. I do not, of course have the figures for 1968. For females, the number rose from 3,497 in 1950 to as high as 11,184 in 1967. That is a total of 41,829, which is the largest figure since 1946, which was the post-war peak. My hon. Friend was quite correct in suggesting that during the war the figures had been very high, for reasons which one can well understand.
Perhaps I might put the figures in another way, and for this purpose I draw upon the memorandum from which my hon. Friend quoted. In 1967, of all young people aged from 16 to 19 inclusive, one in 500 boys and one in 440 girls were known to have contracted gonorrhoea. One in 15,700 boys and one in 32,300 girls contracted syphilis. Of those aged from 20 to 24 inclusive, one in 190 men and one in 450 women were known to have contracted gonorrhoea. One in 7,900 men and one in 23,200 women had contracted syphilis.
It would be wrong, therefore, to think that this is a disease which affects only the teenager. I am glad that this point was raised by my hon. Friend the Member for Willesden, West (Mr. Pavitt). In his Report for 1967, the Chief Medical Officer said that venereal diseases were mainly prevalent not in the under-20 age group but among adults between 20 and 30.
Probably the most important factor which explains the increase in gonorrhoea especially is promiscuity in sexual relationships. A further factor is that modern methods of contraception, which today provide no element of mechanical protection, may favour the spread of 968 gonorrhoea. Perhaps the use of the Pill may well have led or contributed to the increase in recent times.
This is certainly not an issue in which there is any degree of complacency in my Department. On the contrary, this is a situation which causes us a good deal of concern, and we are anxious that there should be a tightening and an improving of the methods which have been practised in this country and which our Department believes to be the proper ones.
The memorandum to which my hon. Friend the Member for Shettleston referred is a very recent document and was issued only in November last year. It was sent out with a circular from my Department to local health authorities drawing to their attention the proposals and information in the memorandum. It was a memorandum which had been approved by the Secretary of State's Standing Medical Advisory Committee. It made a number of important proposals for strengthening procedures and was sent not only to local authorities but to hospital authorities, which, as my hon. Friend the Member for Willesden, West said, have an important part to play in this problem.
In moving the Second Reading of his Bill, my hon. Friend the Member for Shettleston referred to the shortage, as he suggested, of facilities for treatment. I should like to assure him that my evidence is that there are adequate facilities both for diagnosis and for treatment under the National Health Service.
Perhaps I might say a little more about the method which we believe to be the proper way of tackling this social and medical problem. The present system of control and treatment of venereal disease is based on persuasion and voluntary cooperation, and, on the whole, it is working well. The control of venereal disease depends primarily for success on the speedy and effective tracing of potential sources of infection; and I was glad that my hon. Friend the Member for Glasgow, Shettleston referred to the paragraph in the memorandum which dealt with the importance of speed.
§ Mr. Pavitt
Would my hon. Friend confirm that when people are persuaded to use the National Health Service there 969 will be no question of their being charged half-a-crown per prescription when they attend special clinics?
§ Mr. Ennals
I would not like to give my hon. Friend an incorrect answer, and as I cannot confirm that off-hand I will give him the information later.
I was talking about the importance of speed and efficacy. The aim of contact tracing is to ensure that the sexual contacts of people with venereal disease are identified and persuaded to attend a clinic for examination and, if necessary, treatment. Under contact tracing, the patient provides information to an interviewer at the clinic, who may follow up the case in person or may pass the information to a contact tracer. The contact tracer subsequently tries to seek out the contact and persuade him or her to obtain medical advice. If this person is infected, the process is then repeated.
Interviewers and contact tracers are usually employed by local health authorities, and it is accepted that they need special qualities to do their work, whatever their professional background. Both tasks call for tact and patience and, on occasion, courage and resource. While personal qualities are a primary requirement, many of the employing authorities consider that qualifications as a nurse or a trained social worker are essential. An increasing number of those involved in this important work now have training either in social work or as nurses.
As my right hon. Friend the Member for Leeds, West (Mr. C. Pannell) rightly pointed out, success in contact tracing depends on confidence between patients, doctors, contacts, contact tracers and the staff of the health services in general. For this reason hospital authorities have been obliged by law since 1948 to keep information about patients confidential.
New regulations made in October, 1968, however, amended this rule to permit information to be passed to a doctor or person employed by a doctor in connection with the treatment of venereal disease or the prevention of its spread. This was done to facilitate the development of contact tracing. This is an important development which my hon. Friend the Member for Glasgow, Shettleston did not mention.
In the view of the Government, the threat of ratification and compulsion of 970 contacts is likely to deter some patients from seeking treatment at venereal disease clinics. In our view, it is also likely to disturb the cordial relationship between venereologists and their patients, and particularly between contact tracers and the communities from which they seek to persuade named contacts to present themselves for medical advice.
Local authorities are participating in contact tracing to an increasing degree, and the contact tracers themselves would be the last to agree that compulsion would help them in their difficult work. I will come to some of the representations that we have received from those who are involved in this work—this is a delicate and developing task—and they make it clear that their efforts would, they believe be hindered if we adopted my hon. Friend's proposal.
The Bill would institute a system, as my hon. Friend explained, of compulsory notification, similar to Regulation 33B, which was issued as an Order in Council in 1942 under the Defence Regulations, 1939. It is understandable that such measures were taken during the war because, as I indicated, there was a substantial increase in the incidence of venereal disease, largely because a large number of men from the Armed Forces of many countries were located here. They were away from their wives, sexual relationships were on an extremely free basis, so to speak, and, of course, this led to a substantial rise in the incidence of venereal disease.
It is, therefore, fair to say that we had considerable experience of this sort of experiment during the war. Regulation 33B defined as a Special Practitioner a doctor who was qualified under the Local Government Regulations of 1930 as a venereal disease officer, or who was a specialist in venereal disease in H.M. Forces, or who was designated by the Minister of Health for the purpose of the Regulations. The Regulation laid upon this special practitioner the duty of notifying information gained from his infected patients as to suspected sources of infection to the medical officer of health for the county or county borough in which the person who was the suspected source resided.
If the medical officer of health received notification from two or more patients concerning the same suspected 971 source, his duty was to serve the person concerned with a notice stating that that person might require treatment for venereal disease and requiring him or her to submit to examination by a special practitioner within a specified period. In due course, the special practitioner either sent a certificate to the medical officer of health to the effect that the individual suspected was free from infection or served a notice on the individual requiring him or her to attend for treatment or for further tests. The patient concerned had the right to change his or her special practitioner, subject to the obligation to notify the medical officer of health of the details of the change. In the case of default, the medical officer of health was notified by the special practitioner.
The object of Regulation 33B was twofold. First, it was designed to bring under medical care those infectious persons who had shown themselves unresponsive to educational work or to methods of persuasion and who, owing to their refusal to undertake treatment, remained a constant source of danger to the health of the community. Secondly, the regulation was designed to make it an offence for any person indicated as the source of the infection by two or more separate patients under treatment, after being required to undergo examination or treatment, to fail to do so or to cease treatment until certified as not suffering from the disease in a communicable form.
My hon. Friend the Member for Shettleston said that this had been a successful experiment. Indeed, it was a most unsuccessful one. Perhaps if it had been successful my Department and others concerned might have looked with more favour on the proposal which my hon. Friend has made.
In fact, the experiment did not work. On 13th May, 1943, after six months' experience of the working of the regulation, the matter was raised in Parliament with the then Minister of Health, who in answering Questions from several hon. Members reported that 36 men and 475 women had been reported to medical officers of health as alleged sources of venereal infection, of which one man and 27 women had been the subject of more 972 than one report—not a large number in the course of six months at a time when venereal diseases were at a high level. The Minister said on that occasion that no civilian voluntarily undergoing treatment for venereal disease was subject to compulsion to complete it.
The necessity for two separate notifications before action could be taken was the stumbling block to the efficacy of the regulation. Since the vast majority of people were concerned in only one report, many councils authorised their officers to make an unofficial approach on receipt of notification, and in such a case a visit was made by an appropriate visiting officer and the regulation was not used. When the regulation was allowed to expire, on 31st December, 1947, it had singularly failed to achieve its purpose. It is possible that at that time there were those who would have argued that, since its weakness was that it made provision for two notifications, it would have been better had the regulation been based on one notification only, but I think this would have been more likely to lead to the dangers that have been referred to by my hon. Friends during the debate.
By making compulsory treatment dependent upon the suspicions of two or more patients with venereal disease, the Bill opens up the possibility of individuals being the object of false information or of blackmail. The hon. and learned Member for Buckinghamshire, South (Mr. Ronald Bell) spoke about the practical joke. This is a real danger, and it would require only two people to play a very unpleasant joke on an innocent person by notifying that the person was, according to their information, a contact and infected with the disease for that person to be put in an acutely embarrassing position. But, worse than that, if the medical officer of health were convinced of the correctness of the evidence given, and if that person were not prepared to meet the requirements of the Bill, he might then face penalties. We could not put on the Statute Book a Bill which laid us open to that sort of danger, whether it be of genuine false information or, worse still, of the practical joker.
Although the Bill does not place a duty on the medical officer of health unless it appears to him that there is reasonable cause to believe that the disease was so 973 contracted, there is a danger that a successful conspiracy could be established, not just a joke, but a genuine and determined attempt to damage a person's reputation. Such a conspiracy could open the way to blackmail of a most unpleasant kind. I should not like to detail in the House the situations in which a person might say, "Unless you do a, b, c, or d, or unless you pay me a, b, c, or d, then I will ensure that you are notified, rightly or wrongly, as being liable to the provisions of the Bill." While I greatly respect the sincerity of my hon. Friend in bringing forward the Bill, I shall ask the House not to give it a Second Reading.
Many hon. Members have laid stress on health education. This is absolutely right. We have first to ensure that the system of contact tracing is efficient, and this is the purpose of the memorandum which was sent to local authorities and hospital authorities. Secondly, we have to ensure that the sections of the general public 10 whom this applies are aware of the facilities which are open to them. There is little point in their being suitable clinical facilities for diagnosis and treatment if the persons concerned do not know that they can, without fear of public knowledge, come forward freely for treatment. The clinics are open to everyone without payment for treatment. When my hon. Friend referred to prescription charges, he was referring to medicaments, to which I did not give him an answer, but treatment is entirely free.
§ Mr. Pavitt
I can assure my hon. Friend that patients are given medicines as well. There is no charge for prescriptions at special clinics.
§ Mr. Ennals
My hon. Friend, having posed the question, has now provided the answer, and I am delighted to confirm the accuracy of the information given by him.
Health education is of extreme importance. Although health education was not the main purpose of the memorandum to which earlier reference has been made, it was touched on in paragraph 5, which reads:Sources of information are much more likely to be traced if public awareness of the problem is fully aroused by active health education. The screening of special groups is important, e.g. routine testing of pregnant women to reduce still further the now infrequent 974 pre-natal or neo-natal infections and persuading prostitutes, both male and female, to attend regularly for examination as a means of controlling the major sources of acquired infection. Speedy contact tracing is the method most likely to produce quick results; female contacts brought under treatment, especially if they are promiscuous, contribute a disproportionately high degree of success to the control of infection".It is interesting, as that paragraph points out, that not only female prostitutes but male prostitutes can create a danger of this disease.
This problem falls upon the Health Education Council, whose work is now expanding, and I hope that with more substantial funds at its disposal it will use a good deal of imagination in dealing with this. My hon. Frend was right to point out that in educational matters we must bring ourselves up to date and use imagination and modern techniques to bring the message home.
The Health Education Council maintains close contacts with, and actively participates in the work of, the British Federation Against the Venereal Diseases which is a body which emphasises the importance of public education. This very afternoon, while I am speaking, the Director-General of the Council and his senior officers are attending a meeting of the Federation to discuss future developments. In addition, the Council has recently instituted a research programme in association with Dr. William Belson, the Director of the Survey Research Centre of the London School of Economics, into the effectiveness of various kinds of health education methods. In the meantime, the Council is continuing to make available to local authorities and others existing leaflets, posters and other materials, including film strips.
Reference has been made to the views of many bodies. My right hon. Friend the Member for Leeds, West referred to the Josephine Butler Society. This was formerly the Association for Moral and Social Hygiene which was founded by Josephine Butler as long ago as 1870. The Josephine Butler Society has recorded its views against the Bill in strong terms, and I will read two paragraphs from a letter which sets out its views:In 1947 the Minister of Health decided not to renew the Regulation 33B because, far from preventing the spread of venereal disease and reducing its incidence, it discouraged those who feared they might have contracted the 975 disease from seeking examination and treatment. The strictly confidential relationship between doctor and patient was seriously undermined. Moreover, since the complainants remain anonymous, the Regulation is a gross violation of British justice, because it deprives the named contacts of the legal protection afforded to all other persons against defamation of character, whilst gravely infringing individual liberty and human rights. It is, moreover, contrary to Article VI of the United Nations Convention (passed in 1949) for the Suppression of Traffic in Persons and of the Exploitation of the Prostitution of others.A number of other representations have been made against some of the provisions in the Bill. The only other one to which I want to refer is from the National Council of Women. My right hon. Friend referred to the great concern of women's organisations if the Bill were to become law.
The National Council of Women says:Regulation 33B created a precedent in that the private informer provided the basis without which it could not operate. The informing patient remains anonymous, but the contact becomes a suspected person who can only clear himself or herself by the indignity of submitting to a compulsory medical examination. The Bill creates an offence with penalties if the contact fails to attend for or submit to medical examination. This is a grave infringement of human freedom and a human right. Moreover a false name may be given either by a genuine mistake or by deliberate malice and, because of the anonymity, the contact has no redress for defamation of character.Venereal disease is usually a physical consequence of anti-social behaviour and therefore any proposals for its control must be examined for their effect upon the amount of promiscuity. If promiscuous persons mistakenly suppose the State's Regulations will ensure them a clean bill of health, irresponsible behaviour and the spread of the disease will be encouraged.While I greatly respect the intentions of my hon. Friend, many of which will have been achieved by the publicity that the debate will have given to the facts of the situation and the concern which is felt, I cannot advise the House to support the Bill. The best policy is to see 976 that the recommendations made in the circular sent out in November are fully carried out to ensure that the new stimulus which has been given by my Department to contact tracing is made effective. I assure my hon. Friend that we shall review the situation after a reasonable period of time to see whether new initiatives are required.
With that assurance, I hope my hon. Friend will not feel it necessary to press his Bill. I can assure him that the Government are as much concerned as he is about the problem before us, and are anxious to take effective steps. However, I do not think we should attempt to put on the Statute Book a Measure with the social dangers which, inadvertently, my hon. Friend's Bill would create.
§ Mr. Speaker
Order. The hon. Gentleman needs the leave of the House to speak again, but I think that he will get it if he asks for it.
§ Sir M. Galpern
Mr. Speaker, with the leave of the House, may I say that I am very glad to have had an opportunity to ventilate this urgent social problem. We have had a very useful debate, and I am grateful to all right hon. and hon. Members who have participated and made such interesting contributions.
I am still not satisfied that contact tracing will be the ultimate solution in our fight against this scourge. Nevertheless, I fully appreciate that my hon. Friend's Department is gravely concerned about the situation, as we all are.
In view of the assurances that he has given about further investigation into the whole question of trying to contain venereal diseases, I ask leave to withdraw the Bill.
§ Motion, by leave, withdrawn.
§ Bill withdrawn.