NATIONAL HEALTH AND SOCIAL SERVICES

HC Deb 13 July 1970 vol 803 cc1157-288

3.48 p.m.

Mrs. Barbara Castle (Blackburn)

I beg to move, That this House expresses its anxiety that the unrealisable election commitments entered into by Her Majesty's Government are likely to lead to damaging cuts in the social services, including the National Health Service; calls on Her Majesty's Government to maintain the expanding programme of hosiptal building projected in the Labour Government's Public Expenditure White Paper, Command Paper No. 4234, and reaffirms its belief in a comprehensive National Health Service giving equal treatment to all, regardless of their ability to pay. May, I first, congratulate the right hon. Gentleman the Secretary of State for Social Services on his appointment. He has, I know, always taken an interest in social security matters, although he has become more famous recently for his speeches before the election warning businessmen that "Life Will be Tougher Under The Tories", as one newspaper headline put it. We shall be very interested to see whether the right hon. Gentleman brings this tough approach to the work of his new Department.

I am sorry that the Chancellor of the Exchequer is not in his place. We all wish him well. We admired the stamina with which he got through his speech last week in what must have been very difficult circumstances for him. I also regret his absence, because I am afraid that I must inevitably refer extensively to what he said in that speech. In writing to him to send him my condolences for his condition I warned him of this, but I have no doubt that his minions are prepared to spring to his defence.

It is inevitable that the right hon. Gentleman's speech must be the starting point for this debate, because it is the combination of that speech and the appointment to the Department of Social Security of the arch apostle of the abrasive new style of Toryism that gives rise to the anxieties which have inspired our Motion.

The Chancellor did not give much of an insight into his new economic strategy, except to admit, by inference at any rate, that there is neither an economic crisis—even Lord Cromer is now on record to this effect—nor is there as much of a margin for stimulating demand as the Tories indicated there would be during the election campaign.

For the time being, therefore, the Chancellor will coast along on our economic policies, neither taking emergency measures to deal with a national emergency which does not exist nor making the dramatic dash for growth which hon. Gentlemen opposite had always hinted at as being the basis of the fulfilment of their election pledges.

Nevertheless, there was one item of policy in his speech about which the Chancellor was completely specific, and that occurred in his references to public expenditure. Indeed, he told us that his very first task on taking over the job of Chancellor had been to institute a … radical and searching review of public expenditure as an essential prerequisite to our plans for lower levels of taxation and higher levels of savings. This review, were were told by him, was to be completed by the autumn.

This House is rising in a few days' time for perhaps as long as three months. Thus, the curtain will be coming down on the discussions being held within the Government about what are to be the sacrificial lambs to be slaughtered on the altar of public expenditure cuts.

This may, therefore, be the very last chance this House has, before the curtain rises on the Government's policies, for us to warn the Government of the cuts that we would not be prepared to tolerate and, what is equally important, to warn the people of this country of the price that they may have to pay through the social services for the fulfilment of the Government's promises.

I found one of the most alarming sentences in the Chancellor's speech that in his peroration, when he told us proudly: The electorate has returned to this House a majority of Tory men and Tory women. They now expect Tory Measures, and they will get them."—[OFFICIAL REPORT, 7th July, 1970; Vol. 803, c. 510–13.] [HON. MEMBERS: "Hear, hear."] I rather thought that hon. Gentlemen opposite would cheer at that. They react like Pavlovian dogs under certain stimuli. What causes us anxiety is the thought that there is only one thing that makes hon. Gentlemen opposite really drool at the mouth with anticipation—this is significant; it is the only thing on which the Chancellor was at all specific—and that is the theme of cutting taxation.

Mr. Peter Emery (Honiton)

I hope the right hon. Lady will allow me to correct that statement. The theme of this election and of this side of the House has been and is to get value for money. It is the theme of value for money rather than cuts.

Mrs. Castle

That is interesting. I did not expect to draw blood quite so early in the debate. The hon. Gentleman has produced an interesting and significant amendment to the Chancellor's speech. He had better fight that one out with his right hon. Friend, because we did not hear anything about value for money from the Chancellor. Nor did we have any indication of Government policies, except, as I say, to cut public expenditure as being the essential prerequisite to the Tory overriding priority for cutting taxation.

True to form, hon. Gentlemen opposite cheered when I mentioned this Tory pledge to cut taxation. No doubt the country will cheer, too, at this stage, but what matters is how these cuts are to be achieved, in whose favour taxation is to be cut and at whose expense it will be cut. These are the matters that we must examine today.

In doing so, the puzzle of the appointment of the right hon. Gentleman as Secretary of State for Social Services becomes a little clearer, because I do not think that there can ever have been a Secretary of State for Social Services who started his job under a clearer warning from the Treasury. That warning has been that it is not his job to get enthralled by the social needs of the people or to battle in Cabinet for the social services. His job is to accept the fact that his Department is expected to yield the crucial savings without which the only pledge which the Tories care about—the cutting of taxation—can be fulfilled. [Interruption.] There can be no other possible deduction from what the Chancellor said about public expenditure.

The right hon. Gentleman divided his comments into two parts. First, regarding this year, he said: For this year and next year, 1971–72, the latest estimates show public expenditure running rather below the levels planned by the previous Administration that is, by us. Even so, the right hon. Gentleman said categorically: … this balance is struck at a point where the absolute level both of expenditure and of taxation are in my judgment much too high". That is what he said about our estimates for this year and next, and he admitted that we were below the levels which we planned.

Secondly, for the period further ahead, running up to 1975, the estimates, he said—and here he was clearly drawing on our White Paper, Cmnd. 4234—showed public expenditure to be accelerating to regain the levels planned by us. Then he made this curious remark: If I were to permit this to happen I would be committing an annual rate of increase in public expenditure … well above any rate of increase which we have seen in the national output as a whole for many years past".—[OFFICIAL REPORT, 7th July, 1970; Vol. 803, c. 509–10.] That was a very curious comment indeed in view of the fact that our provisional allocations of expenditure up to 1975 were based on the assumption that total national output would increase by 3 per cent. per year, a very cautious and conservative estimate, an estimate which, judging from the claims which they made during the election campaign, hon. Gentlemen opposite would have no difficulty in bettering. Indeed, the one answer which the right hon. Gentleman the Prime Minister gave when asked, in effect, "How are you going to pay for all these promises?" was the word "Growth".

It is this theme which dominates the election manifesto of the Conservative Party, and particularly the section of it dealing with the social services. The fundamental problem of Britain's social services, we were told, was the shortage of resources. This was due, we were informed, to economic stagnation under Labour. The Tory aim was to develop and improve Britain's social services to the full. The manifesto concluded by saying that the only true solution was to increase them by what we could afford. That was a rather self-cancelling argument which, for obscurity, would have been to the credit of any P.R. firm; and, in all probability, it was drafted by one.

The Conservative manifesto puts as the solution to the problem the fact that Government and people must work together to create new wealth. The impression was deliberately left that an expansion of the social services would be financed by higher rate of growth. Yet faced with our estimates of public expenditure for the years ahead, carefully linked to a modest 3 per cent rate of growth the Chancellor retorts The present prospect shows public expenditure in both the short-term and medium-term running at an unacceptably high level and threatening to increase at an unacceptably fast rate."—[OFFICIAL REPORT, 7th July, 1970; Vol. 803, c. 510.] Unacceptable from what point of view? From the point of view of a Government that knows full well that they cannot fulfil their lavish promises to reduce taxation without making inroads on the social services, which they dared not even mention during the election campaign. Indeed, this is the only conclusion to be drawn from the Queen's Speech, which makes it clear that, if everything else suffers, room must be found for Great Power commitments whose cost will far more than offset the modest savings from the abolition of the Land Commission or potential savings to the taxpayer as against the consumer from the promised change in the present system of financial support for agriculture.

There are clearly to be savings in the housing programme too. There has already been a reversal of our policy of the sale of council houses, and there is a statement in the Queen's Speech that house subsidies are to be refashioned. Here again we suspect the worst, but we shall have to wait for details before the implications for the public sector housing programme are clear.

The Chancellor is clearly a long way from achieving the savings he needs even to offset the abolition of S.E.T. For this reason, the omissions from the Queen's Speech are ominous. One of the most glaring omissions is any reference whatever to the National Health Service. There is no pledge to pursue a vigorous policy, as the Speech promised to do in the case of housing. There is no pledge to expand health opportunities, as there is a commitment to expand educational opportunities.

When we couple this omission with the references to the National Health Service in that misnamed document "A Better Tomorrow", the anxiety expressed in this Motion is fully justified. We have every reason to ask, as we do ask, what inroads on the National Health Service will be prepared behind those closed doors during the next three months?

The silence is all the more ominous because in recent months we have had a number of debates on the National Health Service. There was the debate last July and again last December in which the lead was taken by the hon. Member for Farnham (Mr. Maurice Macmillan), now reincarnated as Chief Secretary to the Treasury. If the approach which he then showed to the financing of the National Health Service is now to be reinforced by the attitude to public expenditure of a cuts-hungry Chancellor, we may be facing a situation in which the National Health Service as we know it has been chosen as the main victim of this Government's social service economies.

But this fear is never very far from our minds, because many hon. Members opposite have never really believed in a free and comprehensive National Health Service. It is far too Socialist a concept for them. That is why they voted against the Second Reading of Nye Bevan's Bill. That is why they starved the Service of essential resources during their 13 years of power. That is why they have never been willing to face up to what is involved in maintaining and developing the Service by giving equal treatment to all regardless of their ability to pay.

During their election campaigning against the levels of taxation under a Labour Government, they carefully concealed from the electorate the fact that one of the reasons for that higher taxation by the Labour Government was that we were determined to find the resources to save the National Health Service from the slow decline which it had endured under the Conservatives.

The facts and the statistics are there for all to see. In 1961–62 expenditure by central government on health and welfare services in the United Kingdom was £823 million. By 1969–70 it had risen to £1,580 million; capital expenditure had risen from £52 million to £150 million. In keeping with our revised hospital plan of May, 1966, which visualised the spending of £1,000 million on our hospitals over the next ten years, we have been pressing ahead with the modernisation and replacement of hospital buildings on a scale unprecedented in the history of the Service. The share which the Health Service takes of gross national product has risen from 4 per cent. ten years ago to nearly 5 per cent. today. We doubled the hospital building programme in five years. Expenditure on hospital building in Britain has risen from £68 million in 1963–64 to £128 million in 1969–70.

Under the drive and dedication of my right hon. Friend the Member for Coventry, East (Mr. Crossman), whom I am delighted to see here and who I hope will take part in this debate, because he is far more competent to do so than I am—[Interruption.]—everything is relative and there are degrees of excellence on this side of the House—we were planning to carry forward this expansion at a steady rate on the sort of basis the Chancellor of the Exchequer quoted in his speech last month in such deprecating terms.

In our expansion plan we had allocated over £2,000 million by 1971–72 for the development of the health and welfare services, including £199 million of capital expenditure, about £152 million on hospitals, with further expansions planned in the next two years. We all know that even this rate of expansion was achieved only as a result of levels of taxation which hon. Members opposite exploited to the utmost in the election campaign. Even this rate of expansion is barely adequate for the essential basic development of the National Health Service, yet it is these figures which the Chancellor has attacked as unacceptable.

Dr. M. S. Miller (Glasgow, Kelvingrove)

Will my right hon. Friend accept, in confirmation of what she is saying, that statistics from the Office of Health Economics show that in 1950 when the Labour Government was in office the percentage of national income spent on the National Health Service was 4.42 per cent. It took 13 years until 1963 before that percentage was reached under the Tories.

Mrs. Castle

I thank my hon. Friend for his intervention. We could all during this debate quote figures to demonstrate the neglect under the Conservatives and the price which we had to pay to remedy it. I hope that my hon. Friends will have a chance to participate in this debate so that they may hammer home these facts and figures. This is the essence of the reckoning that now faces our people. It is our figures of expansion past and projected which the Chancellor has denounced as unacceptable.

I ask the right hon. Gentleman whether this means that the expanding hospital building programme which we planned will be cut back and that the urgently needed improvements in the long-stay hospitals, such as the geriatric hospitals and the hospitals for the mentally subnormal, are once again to be delayed, with the tragic human results that we all know.

While I am on the question of cost and expenditure, I should like to ask about the Government's attitude to the Kindersley Report on doctors and dentists' pay and whether it will fit into this determination to cut public expenditure. This is to say nothing of the Government's commitment to curb inflation. It is beyond our comprehension that anybody seriously concerned with the rising costs of the Health Service could have given this report an automatic blessing. Of course, doctors, dentists and consultants in the National Health Service must be adequately remunerated, but the principles on which the recommendations of the Report were based were the most astonishing in my not inconsiderable experience of prices and incomes policy. Not only has the Review Body sought to close the gap between salaries in the Health Service and the other professions which they calculated as arising since the last increases became operative, but the Review Body has actually recapped on its own previous recommendations of May, 1966, arguing on controversial statistical data and highly controversial comparisons that it had not given doctors and consultants enough last time and that therefore adjustments ought to be made retrospectively. Finally, for good measure, the Review Body has slapped on an allowance for future salary inflation up to March, 1971.

I remember how roughly we used to deal with unions which tried to extract wage increases based on those same principles when we were operating the prices and incomes policy. [HON. MEMBERS: "Oh!"] Yes, because we cared about inflation and we had a policy. [HON. MEMBERS: "Oh!"] Yes, and with no help from hon. Members opposite we sought to drive home the lesson, which will have to be learned if inflation is ever to be cured in this country, that we have to get away from irresponsible methods of salary and wage increase fixing. We have to get away from the old leap-frogging and away from the old separation of wage increases from increases in productivity. Hon. Members opposite will learn that lesson some time I have no doubt. Learn it they will eventually, and with great bitterness for the country as a whole.

If we just accepted those principles in this case on the Kindersley Committee's say-so, I cannot imagine anything more calculated to give a further inflationary twist to the upward spiral of wages and salaries. Yet, when we said that we would pay the 30 per cent. to junior hospital doctors, 15 per cent. on account to the rest and seek the advice of the P.I.B. to see how this could be fitted into the principles which we were asking everyone else to accept, instead of giving us the honest backing of would-be honest Prime Minister, the Leader of the Opposition, as he then was, rushed into a piece of instant vote-catching and called our caution totally unjustified. He was indeed nursing the dilemma he has caused for himself, and we are waiting to hear how he is to solve it.

Colonel Sir Tufton Beamish (Lewes)

The right hon. Lady is telling the House about inflation. What is her explanation of the fact that this year inflation is running as fast as it was in 1951, which also followed five years of gross Labour mismanagement?

Mrs. Castle

I will tell the hon. and gallant Member one of the reasons, not the whole reason but one of the reasons. During the past difficult years of economic recovery, hon. Members opposite lost no opportunity to tell wage-earners throughout the country that they believed they had the right to go in and get whatever wage increases they could exact by their economic power. Hon. Members opposite have fought every educational attempt we have made to relate wage increases to rising productivity. Now they will reap where they have sown.

Are we at last to be told this afternoon whether the National Health Service is to have to carry the full award of £85 million proposed by the Kindersley Report together with all the far-reaching repercussions on the other salaries inside and outside the Health Service? Are we to be told that, whatever other kinds of expenditure must be subjected to this "radical and searching review", this item is to be accepted uncritically? Remember, even under the Labour Government's award all hospital doctors, even those receiving only the 15 per cent. payment on account, and ignoring merit awards, will have received salary increases since 1964 greater than the salaries index up to 1969, which is the most recent figure. In some cases they received two increases two or three times the level of the general salaries index.

If this is to be the attitude of the Government the costs of the National Health Service will indeed become uncontrollable. Yet it is this rise in costs about which right hon. Gentlemen in opposition expressed so much anxiety. Some of these rises in costs, as we all know, are inescapable. Wages and salaries are bound to increase. We gave a 20 per cent. increase to the nurses. We gave it gladly in marked distinction from the treatment they had from right hon. Gentlemen opposite when they were in power. A Supplementary Estimate which we have just passed today includes £57 million as the cost of our interim award, which is a sum not to be lightly dismissed. Above all, there are the rising medical expectations following particular developments of medical technology. As various hon. Members have pointed out time and again, the National Health Service creates demand rather than satisfies it.

The Tory manifesto said: the resources going into the Health Service are inadequate. Right, what are this Government to do about that? The Chancellor has already repudiated his party's manifesto by making it clear that he will not use any rise in G.N.P. to finance improvements in the National Health Service, or in anything else. He intends to devote any growth he can get to cutting taxation.

Here we are back to those debates of last July and December on the financing of the National Health Service when we had those notable exchanges between my right hon. Friend the Member for Coventry, East and the present Chief Secretary to the Treasury. Then the hon. Member for Farnham at least had the honesty to sweep away some of the facile arguments which his party was to adopt when the election campaign came. He told us: There is danger in the bland assumption— … He might have been quoting in anticipation his own Leader in the election campaign— that by a mixture of increasing management efficiency, by the better use of available resources leaving the rest to an expansion which one day will happen, the Health Service does not need a greater proportion of our national effort devoted to it. But he did not have the honesty to tell us how a Tory Government would face this problem. It is true that he said he would not find it from taxation. He gave a glimpse of the Tory alternatives: we have to face", he said some system of increase insurance, charges or contributions", But he did not tell us what methods the Tory Government would choose. Nor did the Tory Party have the courage to tell the electorate. Perhaps we will have the answers to these riddles this afternoon.

After all, the hon. Member for Farnham is now established at the heart of the Treasury whose Chancellor is dedicated to cutting back finance for public expenditure. How is it to be done with reference to the National Health Service? Is the Service to be allowed steadily to deteriorate, or are contributions to go up? Are we to have an earnings related social service contribution which was one of the Chief Secretary's suggestions last July? Or is the employer to be asked to pay more, an idea which my right hon. Friend the Member for Coventry, East thought worth examining? The hon. Member for Farnham was full of questions a year ago. Perhaps the Secretary of State can let us know the answers today. It may well be that the right hon. Gentleman is already contemplating as big an expansion of charges as he thinks he can get away with. Even if he does this—we shall oppose him tooth and nail—he will still find that he has not begun to solve the problem of how to develop an adequate health service while cutting the tax element.

Heaven knows, we on this side had enough agony in imposing the increased charges on teeth and spectacles, above all in introducing prescription charges, even though we made as many exemptions as we administratively possibly could. Even with those increases, as was pointed out at the time, the revenue from those charges contributed only a minute proportion of the cost of the service—5 per cent. compared with 85½ per cent. contributed by taxation, central and local, and 9½ per cent. from the National Health Service contribution.

There are some charges, such as those for amenity beds, which have been part of the fabric of the Health Service since its inception and which cannot be said to infringe the principle of not taxing people when they are sick for essential medical care. There are others, like prescription charges, which come perilously near doing so simply because in practice it proves impossible to exempt all the categories one would like to exempt—to distinguish for example, between the person who is just wanting an aspirin or a sleeping tablet and all those who are chronically sick. That is why we would never have imposed prescription charges except in a situation of acute economic difficulty when the only alternative would have been to cutback something of even greater priority in the Health Service, the urgently-needed expansion of the hospital building programme.

We remain committed to restoring a free Health Service as soon as the priorities of expenditure within the Services makes this possible.

The approach of hon. Members opposite is very different. They believe in charges for their own sake. They have never believed in what the hon. Member for Farnham called a Health Service free at the point of use". It would present no ideological difficulties for them to propose new charges such as a charge for a visit to the doctor or a boarding charge for hospital in-patients. Indeed, the hon. Member for Farnham made this perfectly clear in the debate last July: We on this side of the House have recognised always that the taxpayer's commitment can only be limited by some form of payment for the service when it is used; in other words, some form of charges, with safeguards."—[OFFICIAL REPORT, 1st July, 1969; Vol. 786, c. 249, 251–2.] Perhaps some new forms of charges will be waiting for us when the curtain rises on the Government's deliberations in the autumn.

It may be that something much more far-reaching is in preparation. As my right hon. Friend the Member for Coventry, East pointed out in the excellent Herbert Morrison memorial lecture that he delivered last year, even if these two new taxes on sickness—a charge for a visit to the doctor and hospital in-patient charges—were to be introduced "with safeguards", the yield could not be pushed above about £30 million a year out of a total bill for health and welfare of £2,000 million.

That is why a seemingly innocent sentence in the Conservative election manifesto takes on a new significance. In the section on the National Health Service, the following appears: Labour see 'danger' in the growth of private provision in health and welfare. We believe it right and proper that people should be free to provide for themselves and their families if they wish. [HON. MEMBERS: "Hear hear."] Yes; this is the policy of hon. Members opposite. No doubt in the next three months we shall have the crystallisation of that instinctive reaction into new and destructive policies.

What we fear is that the Secretary of State and the Chancellor are together cooking up plans which will ensure the effective destruction of a comprehensive National Health Service offering equal treatment to all citizens regardless of their ability to pay, under the guise of leaving people free to make extra provision to pay for themselves if they so wish.

We fear this for two reasons. The first is that even in their present attenuated form the private insurance schemes, of which B.U.P.A. is the largest, are already buying certain favourable treatment for those who can afford to pay. They are buying priority in time for an operation which is not urgent—in other words, queue-jumping. They are buying the right to the services of a particular consultant. They are buying beds in private nursing homes.

Yet patients in these schemes are heavily dependent on the existence of a national publicly available health service which alone can provide the resources for dealing with real medical emergencies—something far bigger than a privately engaged consultant trotting along to a private nursing home, often with his own equipment, to do a routine operation on a private patient and suddenly discovering that his patient's condition is complicated and critical can hope to deal with. The private patient may then owe his life to the vast reserve resources which only a truly national service can provide.

At present, the private insurance schemes are not large enough to be seriously significant. They neither particularly relieve the burdens on the Service, nor do they seriously undermine it. In the year ending June, 1968, these schemes provided benefits for 1¼ million adults and children and in that year they collected £14 million in insurance and paid out £12 million in benefits. Even though these figures have risen since, they are still a flea-bite in relation to the cost of a national service.

What if the Tory Government were to try to finance the Service by actively encouraging the extension of these schemes—by allowing, for example, contributions to rank as a deduction against income tax, with the result that the number of people in these schemes quadrupled or even more? Then indeed we should begin to see the development of a two-tier Health Service in which those who could afford the premiums would jump to the head of the queue and those who were too poor to even pay income tax would be left with a second-class service.

Our second fear is this. Following on the famous debate last July an advisory panel of the B.M.A. has produced its own answer to the financing of the National Health Service. In 1967 the B.M.A. commissioned a study of this problem whose report was published recently. This is far too complicated a scheme for me to spell out in detail to the House, but I would like to outline its basic principles. The Health Service, says the report, desperately needs more money. We are all agreed on this.

Here I draw the attention of the House to one passage of vintage charm. I quote from the summary of the report published in the B.M.A. Journal published on 25th April of this year: Though the total cost of the health and welfare services has risen from £830 million in 1959–60 to £1,770 million in 1968–69 and has been rising faster than G.N.P. in recent years, this is only because savings have been made in the defence budget to enable other public expenditure to rise faster than G.N.P. It is probable that we have come to the end of that particular road. The authors must have been anticipating the disastrous return of a Tory Government.

The report suggests that there is only one solution. We had better divide the Health Service into two parts: on the one hand, the hard core of the problem, the hospital building programme, research, care of the aged, the chronically sick, the mentally subnormal—and finance that out of taxation. On the other hand, there would be the remainder of the medical services which should be financed by compulsory insurance to cover all other in-patient and out-patient costs, general medical, dental and ophthalmic services.

But anyone would be entitled to contract out of the compulsory health insurance scheme provided he joined a voluntary insurance scheme offering higher benefits. So once again we are back to the old theme—how to create and entrench medical privilege. "No longer", says the report—here again I quote from the summary— would any patient be compelled to pay twice for medical care (once through taxes and once privately) if he wished to secure a higher standard in some aspects of medical care than the State is able to provide. Yet, as The Times pointed out in a leading article when it appeared, heavy premiums for compulsory insurance would have to be paid by people who are far from affluent and the cost of the Health Service falling on the modest income household would actually increase substantially, particularly for the parents of families.

So what we are offered here is a crazy scheme which would produce no new physical resources for the Health Service, take medical resources from the poor and the not so poor to give them to the rich and do it by a special new tax on parents which they would have to pay on every child, unless they could prove poverty. I cannot imagine anything more calculated to destroy the whole unifying philosophy of the Health Service while redistributing the financial burdens in a quite intolerable way, and at the same time placing new burdens in a new form on the very people who were lured into voting Tory at the last election because they believed taxes would be cut. Perhaps it would not have been necessary even to mention this scheme today if it had not been for the fact that a member of the Advisory Panel which produced this crackpot scheme is the hon. and learned Member for Reigate (Sir G. Howe), who is now Solicitor-General for the present Government. I hope that the Secretary of State for Social Services will emphatically repudiate his hon. and learned Friend's announcements this afternoon.

There is one simple proposition that we have to decide today. The Prime Minister made great play, in his moment of election victory, with his desire to create "one nation". Is he prepared to apply that principle to the National Health Service? The creation of that service, as other countries are the first to recognise, has given us one of the fairest, the most socially just and the most unifying elements in our whole society. For all its faults and all its difficulties, it embodies the principle of equal treatment for all regardless of ability to pay. Is the first act of this "one nation" Government going to be to destroy that principle? If so, I hope the Prime Minister will let us have no more of his Disraelian cant. If I have maligned him, he has one simple remedy. He can call on his hon. Friends to support our Motion this afternoon.

4.32 p.m.

The Secretary of State for Social Services (Sir Keith Joseph)

I thank the right hon. Lady the Member for Blackburn (Mrs. Castle) for her courteous references to my right hon. Friend the Chancellor of the Exchequer and to myself. The election, or rather one election is, of course, already over and the country has decided. But there is another election facing the party opposite—the election of the Shadow Cabinet—and I think the right hon. Lady can be sure, on her past record even if not the rather thin speech she made this afternoon, that she will secure her place in it.

It was a very thin speech, even though she stuck womanfully to her written brief—all that elaborate edifice built on the assumption that the tax cuts can only come from the Social Services. No one would think, from the right hon. Lady's speech, that the first Bill presented to this Parliament, which I had the honour to introduce last Friday, actually proposed, if Parliament agrees, the expenditure of £30 million for three of the groups which are most deserving in our country. No one would think that if hon. Members opposite were to look at the history books they would find that, in our 13 years of office from 1951–1964, we did improve the standard of all the social services and that we did cut the rates of personal taxation. We did both simultaneously.

Yet the right hon. Lady is intent on boding, on croaking, and at this stage in Parliament it really was very tenuous stuff. Let me give her from the past—though we do not want to hash over old figures—one sharp distinction in parformance that perhaps is not familiar to the country. During the 13 years of Conservative office the real value of the retirement pension rose on average by 4 per cent. a year—49 per cent. in the 13 years, which is just short of 4 per cent. in real terms per year. During the Socialists' five and a half years just past, the real value of the retirement pension rose by 14½ per cent.—[An HON. MEMBER: "Twenty per cent."] No, that does not take into account the lapse of time and the rise in prices since that 20 per cent. calculation was done. I have been given from unimpeachable statistics a figure of just over 2½ per cent. rise in real terms per year compared with our 4 per cent. rise per year during our 13 years.

The right hon. Lady should be ashamed, as her right hon. Friend the Leader of the Opposition should have been ashamed, to use figures that disregard the rise in prices. She had the gall to say that the hospital building programme has doubled under Labour. So it has in money terms, but in real terms it has gone up at the rate of 10 per cent. per annum during their nearly six years in office, a rate which compares with our 25 per cent. in real terms—and I will not deliberately misuse figures—during admittedly our last three years of office. [HON. MEMBERS: "Ah."] If right hon. and hon. Members opposite are to claim great credit for increasing the health centre programme from virtually a standing start—we do not dispute that—why should not we claim credit for the sharp increases in hospital building which we really started in the early 1960s?

I will depart from the past in one moment, but I really must draw the attention of the House to the evidence of the manifestos. The Labour Party manifesto devoted eight lines, four misrepresentations and one very vague commitment to the Health Service. My right hon. Friend's manifesto contained 23 lines, no misrepresentations and a large number of commitments.

After six minutes, compared with the right hon. Lady's 40 minutes, I will now turn away from the past to the present and the future. First, there is the very large question of pensions. We are pledged to introduce a reconstruction based primarily on funded occupational pension schemes. A great deal of work has been done by the Conservative Party in opposition on these proposals, and I count myself extremely lucky to have helping me my hon. Friend the Member for Somerset, North (Mr. Dean) who has done so much on it. The design of the new scheme is in hand.

I think I should start what I have to say about the National Health Service by saying at once that it is a very great privilege to preside over this Service. It is in part superb; it is in part not allowed to be superb because there are not the resources. It is potentially superb throughout if we can get the resources and the mechanisms right. It is short of money. There is virtually no limit to what the National Health Service could spend, but there is a very sharp limit to what the taxpayer is willing to spend. It is at the moment, as the right hon. Lady said, about 85 per cent. paid for by taxation, central or local, and yet, despite this, it will be common ground on both sides of the House that all is not well with the Service. Doctors are leaving the Service and this country. There is a shortage of resources and staff. Waiting lists are lengthening. Many people are in hospital who should be treated at home or by the local authority services. All the while standards, expectations and possibilities of the ever-more refined sophisticated treatment are all rising. This is the background against which the manifesto says that resources going into the Health Service are inadequate. Our intention is very clear. It is to improve the Service. But before we can answer categoric questions such as those put by the right hon. Lady, we need time to consider priorities and balance. We should be wrong to validate automatically every forecast and extrapolation which the previous Government put to paper.

We need time particularly, perhaps, to consider the building programme. We on this side can be persuaded that vast buildings are right, but we start by looking sceptically at arguments drawn from scale. We wish to take time to make sure that we have the right balance between hospitals, on the one hand, and community services, on the other. We do not know—no one has done the study yet to be sure—that either the previous Conservative Government in their Hospital Plan or the Labour Government had this balance right, and I for one flinch when I hear stories of the 1,000-bed district general hospital having to grow to an even more monstrous size.

We start with this sceptical attitude, and there arrived on our desks at the weekend what seems to me to be a very respectable study done by the Office of Health Economics—from which one hon. Gentleman quoted—called "Building for Health", which, without any dogma, calls in question the present distribution of the capital building programme. We can all agree that the local health and welfare services are as important to health as hospital services. I have always felt, on this subject, from my days in opposition, that what the Health Service would lend itself to above all is study by the operational research mathematical specialists, who would study the way the benefit to the public can be optimised by the method of location of capital and revenue spending. I shall see whether it is practical to study the problem by this technique.

We need time, therefore, to study the capital building programme. We need time to review alternative sources of revenue. I quote from the right hon. Gentleman the Member for Coventry, East (Mr. Crossman) in his recent lecture: An increasing number of people are becoming convinced that we must look for alternative sources of revenue. This side of the House, as the right hon. Lady correctly said, does not have the ideological trauma about charges which many hon. Members opposite have, but what we do have—which, perhaps, is very nearly as efficacious—is an acute sense of the real limitations on charging. The effect on the patient, the need for exemptions, the paper work, the amount of revenue raised for the amount of trouble caused—these are all valid points, but I am sure that the House will not disagree when I say that, despite these difficulties, we must, as the right hon. Gentleman himself said, search for alternative sources of revenue. In the same lecture, the right hon. Gentleman put my point of view when he said that: each case should be considered on its merits". If hon. Members wish to look at what seems to me to be a sensible statement by a layman, they should turn to the article in today's Guardian by Brian Lapping. Like the last Government, we shall look at all possibilities, but I can confidently assert that the Health Service will continue to be paid for very largely out of taxes and contributions.

I turn now to more immediate subjects. The right hon. Lady was good enough to give us her views on the doctors and dentists dispute, a dispute which I was unhappy to inherit. I am glad to say that we have re-established the concept of the independent review body, subject to the right of the Government to reject or modify any particular recommendation—[Laughter.]—I come now to the magic phrase enshrined in Pilkington—for "compelling reasons". We are now in the midst of discussions on pay, so the right hon. Lady will well understand that I cannot comment on what she said.

We shall before long bring to the House the timetable for putting into action the legislation on Seebohm. We have before us the Green Paper proposals on reorganising the Health Service and some of the comments on that Green Paper. This whole massive reorganisation is something which we shall have to consider closely in conjunction with proposals for local government reform.

The right hon. Gentleman the Member for Coventry, East and I seem to succeed each other. He followed me as Minister of Housing, and here I am in his old post. I remember kindly that he even thanked me publicly for some initiatives which I took as Minister of Housing, though I do not remember that he ever acknowledged the extra land which was awaiting him or the strongly accelerating trend which he inherited in public and private housing—but, then, he is not quite a saint, perhaps. Now it is my turn. The Service is short of funds. Doctors and dentists are, or have recently been, in dispute with the Government. There are many things which he and I would agree are wrong, though we might not agree on how to cure them, but I have two acknowledgements to make to him.

First, I find that the Department under his leadership has invested a great deal of effort in work on mental handicap. I have made only a preliminary study of what has been done, but it seems to me to incorporate a most sensible approach. I must say that, despite all the work—he will be the first to agree—no extra financial resources have been allocated. He was hoping to switch resources internally. We shall be considering our policy. Meanwhile, I assure the House that the indispensable preliminary work for any improvement of the treatment of mental handicap, that is, the training projects, has been started.

I acknowledge another initiative on the right hon. Gentleman's part, that is, the Hospital Advisory Service which he set up. I believe that this service contains the possibility of, by persuasion and goodwill, raising the standard of performance of the long-stay geriatric and mental handicap sides of the Service.

Next, I pay tribute to the medical profession and the nursing, technical and ancillary staffs in the Health Service. They are enormous in number, superb in quality, and internationally admired for dedication. We all know that a full establishment of satisfied skilled people is more important than anything else. Without it, nothing else can be done. But I say to the House—I think that this is a point of view agreed by at least all my right hon. and hon. Friends—that there is a place, too, in the National Health Service, however endowed it may be, for volunteers. I am not suggesting that volunteers can be a substitute for the work of paid staff, but they can be a supplement in hospitals and in local authority services. They can make the humanising link between the health and welfare services in the community. A large variety of bodies is already in action. The scope is almost unlimited. We shall have to move prudently so as to minimise disappointment to clients and disappointment to volunteers, but I have asked my hon. Friend the Under-Secretary of State, who will seek to catch the eye of the Chair later today, to concern himself particularly with the scope in this area of the Health Service.

One other feature of the National Health Service is clear. The efficiency and humanity of the Service cannot be measured only inside the hospital grounds. It is equally vital outside the hospital in the local authority services and in the community. If one were looking like a bird upon the ramifications of the Service as a whole, one would see, I think, by no means a solid land of health and welfare but an archipelago with islands of excellence and with great gaps in between into which the citizen can only too often fall.

The key word which I have in mind when approaching this problem is the word "linkages"—linkages between the local authority services, the voluntary services and the hospital services, linkages between the medical, the social, the health, the housing and the educational services. Above all, I think of those little sung but wonderfully humane people, the home helps, who we should all like to see in greater abundance, who are a notable invention of this country, and who can bring comfort where otherwise there would be no aid. I mention home helps, but I could equally mention health visitors, district nurses, the psychiatric social workers, the medical social workers—the great range of armies within the health and welfare field.

This question of linkages is important to all the citizens, but perhaps it is most important and most vital to the least articulate citizens, to the mentally handicapped and the mentally ill, to the elderly, to the disabled, to the poor and to the inadequate. We in the House as a whole are acutely aware that poverty still remains in this land.

We inherited, alas, no rapid pace for dealing with this problem. The right hon. Lady will herself be the first to admit that during the last five years the plight of the low-earner has become if anything, because of the impact of inflation and the effectiveness, such as it was, of the wage freeze, worse than before, and we know that there are very many—[HON. MEMBERS: "No. Not true."]—I quote from innumerable trade union resolutions which assert that this is true. We know that where these lower earners, many of whom are in Government employ, are the sole support of households with children then a serious plight can ensue for a family.

I have to say, in what I hope will not be otherwise considered a controversial speech, that in dealing with two groups of the least well off in the land Labour were in fact very slow off the mark. I refer to the disabled and the one-parent families. Mrs. Ann Armstrong wrote in The Guardian about the plight of the disabled in March, 1962. The Disablement Income Group, under the late Mrs. du Boisson, started crusading shortly afterwards. Both parties espoused the cause of the disabled. Yet it was not until October, 1967, I think during the reign of the fourth Minister appointed to co-ordinate the social services, that the Government even announced a preliminary study of how to deal with them. Now, I call that a very slow start indeed. So we have inherited an analysis that is not yet full enough to enable us to understand completely the position of the disabled.

It is worse still when we come to the one-parent families. Mrs. Margaret Wynn wrote "Fatherless Families" in January 1964. A Committee to study the plight of the fatherless families—the one-parent families, because there are motherless families as well—was announced in March 1969. So the Ministers responsible for co-ordinating the social services had been doing nothing for four and a half years. Of course I make no criticism of the Committee itself, which was set up under Mr. Finer in 1969. There are many complex problems affecting these people. We had recently the article on "The surtax on the poor" by Professor Prest.

We know the problems which have to be met, but above all we are aware of the areas of multiple distress where almost every family bears an accumulation of disadvantages. I note the remarkable contrast between the meticulous report of the Chief Medical Officer of my Department recording almost every disease and the numbers who suffer from it during a year—the contrast between this and the plight of the hundreds of thousands, perhaps even a million or two million, people who live, as I say, in the area of multiple distress, a problem which no Government have yet really discovered how to solve.

I turn from areas of distress to an agency of government which I think we all admire, the Supplementary Benefits Commission. In my short time in the Department I have been very impressed by its work. It bears an immense load. We all know the competence of the officials of the Commission.

The vast majority of clients of the Supplementary Benefits Commission are thoroughly respectable elderly citizens; in fact, 70 per cent. of beneficiaries are the elderly, the retired; and most of the rest are the genuinely sick and the genuinely unemployed, or are cases of genuine desertion. There is a minority, relatively speaking, but nevertheless a significant minority, who abuse the supplementary benefits system. The Commission has been very active in dealing with abuse. I have great sympathy with the officers who have to balance their duty to help genuine cases with their suspicion in some cases. It is easy enough here to say this, but they have to walk on a knife edge of discretion.

Much has been done but after examination it looks to me as if there may well be more to do. There are several possibilities which I am considering with officials. Now I must go deeper, and then I must talk with the Supplementary Benefits Commission itself. It is quite plain that in a free society we shall never eliminate all scrounging, but we are determined to reduce it.

Mr. Charles Loughlin (Gloucestershire, West)

I am interested in this, because when I was at the Ministry of Social Security we took certain steps to try to identify those who were alleged to be scrounging. We had great difficulty, but we did have certain procedures. Can the right hon. Gentleman tell me what the difficulties are in operating those procedures?

Sir K. Joseph

No. I am not suggesting difficulties about the procedures. I am simply telling the House that I have been examining, and that there are further possibilities. I have not yet discussed them with the Commission, but with officials, as I said.

Before concluding, there is one particularly awkward issue on which I think I should inform the House where our present thinking is. There is much pressure for an inquiry into abortion now that the Act has been on the Statute Book in effect for two full years. It is not yet clear whether the time is ripe for a full inquiry. I am making a study of all the facts before reaching a conclusion, and I shall, of course, be interested if any hon. Members on either side wish to let me have their comments. So as to keep the Government's hand relatively free without discouraging the essential maintenance of standards, I have decided that, for the moment, no private nursing home shall be approved for a period longer than the end of this year.

So the range is wide—pensions, social security, health, welfare, including some of the most intractable pockets of hardship. I confess to the House that, despite my long-standing interest in the subject, there is an enormous amount for me to learn. There are many problems. I trust that, despite the rhodomontade of the right hon. Lady, the House will believe that our purpose is to improve, to encourage, to help. If I am biased, it is to recognise that, important though every human being is, it is the family which, above all, matters. The family is the unit I shall have much in mind. I hope the House will reject this scare-mongering rubbish of a Motion, and accept that our purpose is as I have described it.

4.58 p.m.

Mr. Neil Kinnock (Bedwellty)

I rise to make my maiden speech. I am particularly happy to make it on the subject of health and social security because the House will know that Socialists in my part of the country, South Wales, have made a unique contribution to the design and development of our National Health Service. Though I cannot hope to rival the talents and vision of Jim Griffiths or Aneurin Bevan, I can bring to this House some zeal for social justice and provide a continuity of interest in this subject.

My predecessor, Mr. Harold Finch, also belonged to this generation of giants, was an expert not only in social welfare but also in miners' compensation, and it earned him respect in this House, and, indeed throughout the country, and, so I am informed, throughout the world. Because of the way in which he applied his knowledge I can certainly testify to the genuine affection which it earned him in the constituency. I am sure that his dear wife is a familiar figure in this building and that the House will want to join with me in wishing them a long and active retirement. Mr. Finch's retirement is likely to be marred by only one single fact, which is that, for the early years of it, at least, it will be under a Conservative régime, something which does not commend itself very easily to his palate.

We have a Tory Government, a Government which, on the basis of the pronouncements since 1st July, the election manifesto and even the compassionate speech of the Secretary of State for Social Services, not only economically but socially are prepared to stampede back to the barren prairie lands of laisser-faire. The Government, who are seeking to please all the people all the time and will succeed in pleasing only a tiny élite few have produced two glorious non sequiturs.

First, there has been a lot of talk about compassion, and this from a party whose very existence is an illustration of rapacity and selfishness. To me and to the people of South Wales that is what Conservatism means. I make no apology for giving their definition, because they are the people whom I represent.

Secondly, we have had the pious palava of creating "one nation", and this from a Government that is prepared in the name of the god "choice" to encourage the development of private alternatives in education, welfare, insurance and health—[Interruption.] There is no order of the House that demands that I make a non-controversial speech. I am talking about a controversial subject, a matter of life and death, and nothing is more controversial than that. There will be the same old formula of privilege, selectivity take the hindmost, which will neither give success to the Conservatives nor, more important, ameliorate the distress of the people seeking assistance from the health services, national insurance and other benefits of the Welfare State.

Perhaps I have a suspicious mind, but the South Wales valleys breed suspicious minds, and I have reason to believe that the "one nation" party is conducting a survey of the Welfare State system and the National Health Service with a view to undertaking extensive mining operations. Doctors and nurses who are so desperately needed in the public health system will be sucked out of the pool of medical manpower into private medicine, where they will be available to few people. New developments in medical technology will become available in the first instance and for some time to come only to people who can afford to pay either through heavy insurance premiums or directly. Public confidence in the National Health Service will be eroded by governmental neglect and by the garish shop window of private health schemes. In the words of Aneurin Bevan, we shall have a nation divided by the salt, some above, some below. I am in this House, and I hope that other hon. Members on this side are, to knock the salt off the table so that there is universal provision of the best regardless of a person's background or income. Only in this way can we afford to hold up our heads when we talk about a health service.

There are probably people on the other side of the House who are very nice—[Laughter.]—perhaps most of them are out of the Chamber at the moment, but there probably are some nice people. The nice, kind people have confused their niceness and kindness with the idea of compassion. I am not saying that there are no compassionate people, but what I have read in the Conservative Party manifesto, what I have heard so far today and suspect I shall hear for the rest of the day has little to do with compassion. Compassion is not a sloppy, sentimental feeling for people who are underprivileged or sick, to be used as a tearjerker or as an expedient at the time of an election. It is an absolutely practical belief that, regardless of a person's background, ability or ability to pay, he should be provided with the best that society has to offer. That is compassion in practice; anything less than that is sheer sentimentality. It is impossible to be compassionate while at the same time promising to cut public consumption for the sake of buttressing-up private choice.

Illustrations of this non sequitur, this paradox, that runs right through the policy are many. The manifesto refers to the contribution made by voluntary services to the National Health Service. No one appreciates more than I do, as a member of a regional hospital board, that this is an excellent way of providing State care with a human face. I support the development of voluntary systems, but if increasing voluntary activity means going beyond youngsters and citizens being involved in the running of hospitals and caring for the aged, the sick and the weak, and results in transforming half the Health Service into dependence on voluntary donation and philanthropic management, that will be a different matter altogether. We did away with a "flag day" health service many years ago. The slightest step in that direction will earn the fury of the people of this country, and I shall be in the van of that fury.

We are told that the development of the Health Service will be financed only out of economic growth and not through the reallocation of resources from other Departments. That leads to two questions. Will the families who do not have immediate access to universally available health facilities feel secure and serene enough to bring about the increased productivity we require for economic growth? I do not think they will, not because they are selfish people, but because they cannot connect their standard of living with a vague and incomprehensible national growth target.

Secondly, if the Government are concerned about out-dated hospitals, the efficiency of community services and the lack of co-ordination between the three branches of the Health Service, why was so little done about it in the last Conservative Administration? We allegedly had the growth rate then, and we certainly had the problems, but little or nothing was done about them.

I am pleased to know that an undertaking has been given that there will be more health centres. We shall be particularly glad in Wales, because we understand what a blessing they are. We now have 13, and 14 are in process of construction. They are a novelty to us. All of them have been built since 1964. Before then for 13 years not one was built.

We are told that we have had a "programme for Parliament". After all the answers I have heard during Question Time and the statements which have been made during debates, I am beginning to wonder which Parliament we have a programme for. We have been told nothing. We have not even had a gratuitous promise. We have had no statement about the Green Papers on reorganisation, and we have had no commitment to a reorganisation of the Health Service. There has been no mention whether the Government are now to extend the practice of screening which involves the application of modern medical technology and could save countless lives since it diagnoses disease at an early stage. It is a natural extension of the National Health Service and we should like to know whether the Government intend to adopt screening on a widespread basis.

What have the Government to say about giving universal application of dramatic technological advances so that they may be available to ordinary people? Suspicions are bound to arise when we read that the Conservatives believe that people should provide for themselves. Does this mean that people will have access to heart, lung and kidney machines only if they can afford to pay for them? One cannot blame people for being suspicious when they have no ground to believe otherwise.

My constituency of Bedwellty is situated in the coalfields and has a consciousness that is shared by people in similarly situated communities. In those communities we have a preoccupation with community help. We have more than our share of old people, we have a much higher than average rate of infant mortality and juvenile morbidity. These are the main problems to be tackled.

There is no major general hospital available to people in the constituency and we do not enjoy the immediate services of any of the primary specialists, such as gynaecologists and obstetricians. Access to the surrounding hospitals is limited by preposterously high bus fares. The cheapest fare to get to any hospital within my constituency is 5s. 2d. and the most expensive runs up to 12s. Looking at the party opposite, I cannot see that this situation will be bettered within the life of this Parliament.

The Secretary of State said in rather unkind terms that he likened the commitment of the Labour Party to social security to the worship of a sacred cow. My attitude and that of the people in my constituency, and indeed that of all hon. Members on this side of the House, to social security and health matters is that there should be an opportunity for fair treatment for everyone. This is not an attitude of the sacred cow but an elementary characteristic of our claim to be a civilized nation.

5.15 p.m.

Mr. Hugh Dykes (Harrow, East)

My genuflection on this occasion to the traditional sentiments of trepidation and anxiety in making a maiden speech is not merely traditional. It is genuinely held. I should like to congratulate the hon. Member for Bedwellty (Mr. Kinnock) on an excellent maiden speech.

My diffidence today arises from the fact that we are debating a matter on which there is a good deal of confusion and misjudgment that is not necessarily restricted to one side of the House. I am also conscious that I follow in my maiden speech not only those who have made such speeches in this Parliament but many distinguished Parliamentarians before me. Even the broadcasting media have paid tribute to the excellent standard of maiden speeches in this Parliament, which again increases my acute sense of anxiety.

I am also anxious because I am conscious that as a newly-elected Member for Harrow, East I have the honour to represent a vitally important constituency, which is part of the London Borough of Harrow and is known by social scientists as a dormitory area. That is a neutral phrase, but it really says nothing apart from being a descriptive label. In fact, it is a vital and lively constituency which is proud of its traditions, is part of the life of Middlesex, an area which is hopeful for the future. It has a lively social, political and religious life and its record in arts and sports is equal to that of any other community.

Furthermore, it is renowned for the beauty of its green belt, I should be straying a little from the terms of the Motion if I were to enter too greatly into that matter, but that is also part and parcel of the general welfare of the community.

I wish to pay tribute to my predecessor, Mr. Roebuck, who during the last Parliament represented Harrow, East with energy and skill. I hope that I shall learn from his record.

I am grateful for this opportunity to address the House because in the social services my constituency has a record which is second to none. This applies to general services and in discretionary services in the community specifically designed to try to alleviate individual cases of need, hardship and distress. This underlines the basic philosophical divergence between both sides of the House on the practical ways to achieve certain goals about which there may be a great degree of general agreement.

I do not accept the words in the Motion that … unrealisable election commitments … are likely to lead to damaging cuts in the social services". There is something illogical in that phrase since if the commitments were unrealisable it is difficult to see how they would lead to damaging cuts in the social services. I do not believe this to be true, not only because of the record of the previous Conservative Administration and its relative success—and it is "relative" because it is largely a question of conflicting priorities—but because we on this side of the House will have a programme which will lead to success in the vital matter of providing social services.

When the Motion talks about cuts we should bear in mind the hospital building programme which has taken place in the last five years as compared with what happened under Conservative Administration. Taking the whole aggregate increase, this programme increased in percentage terms at a faster rate under the Conservatives than in the period which followed. The figures in money terms are 92 per cent. under the Conservatives as against 69 per cent. under the previous Government. The difference is more marked when one allows for inflation. The Conservative Party has shown and will show that we have the determination to attach a high priority to the social services and to achieving practical success in attaining those objects.

A number of speakers have referred to a faster rate of growth which is implicit in everything we say. This is not a controversial matter. On the other hand, the matter of how this is to be achieved is controversial as will no doubt be shown in succeeding debates.

The next task for the Government, which is a central matter in the reform of social spending in the National Health Service, is in the reshuffling of priorities of receipts and the maximising of results. This will depend on fundamental changes in the way in which receipts and spending are organised and constructed. The National Health Service itself in terms of structure of receipts and spending will probably be little changed. There is some difficulty in determining how people should pay individually within the context of the Service.

None the less, the important realities of anything that we in this House discuss pertaining to the social services, today and on other occasions, must be as follows. Unfortunately, affluence has not meant an inexorable increase in the quality of the services provided. Unfortunately, there is not only the evidence of C.P.A.G. but other expert judgments that priority categories of need have not kept pace. I would include in all the services that people receive as individuals or groups in any measurable determination of poverty or affluence also the services which they receive collectively or individually from the National Health Service. That is a moot point in any major debate on the subject. Next, the National Health Service is under considerable strain. That is no shame on the operatives in the Service. I am sure that we all wish to pay tribute to them. It is because of the last proposition, that the demand intrinsically for these services is not limited but that resources are.

Coming back to one local item, I am proud to be able to mention Northwick Park Hospital, which is in the region in which Harrow, East and the Borough of Harrow are included. It is a new specialist and general hospital which is at present in phase 1 of its development. It is expected to be completed by 1974. It will be a striking achievement and a very useful addition to the general and specialist services in the North-West London area. It will be a hospital primarily serving Harrow, Brent and Ealing, but also with a national element, combined with the Medical Research Council, into specialist diagnostic and investigatory services of all kinds. By the end of this year, there will be in the hospital 204 local beds and 60 national beds. By November there will already be some out-patient services operating, and some supporting diagnostic services. Local general practitioner services are also to be integrated and related to the hospital, and I believe that it will be the pattern for large purpose-built modern general and specialist hospitals in the future, providing an integrated building with integrated services serving the community in different ways and responding to different needs.

Returning to the specifics of the Motion, the Green Paper published earlier this year did not touch on the question of finance. Finance is the heart of the problem, and the allocation of resources is part of that heart. Both sides of the House examining this objectively will acknowledge the unfortunate and sad position of the previous Government in that, despite their good intentions, they did not achieve their objectives in the National Health Service and the other services. Real spending on the National Health Service and other services scarcely rose at all when, over the period, the national tax take doubled.

One example of mistakes arising out of good intentions is that prescription charges were abolished and then reimposed in crisis conditions. If prescription charges had been recognised as one way of raising additional urgently needed finance for the Health Service, with specially exempted categories taken care of, there would have been an extra £75 million of resources for such priorities as hospital building, the care of the elderly and special care for the mentally handicapped. That compares quite favourably with the latest figure of £120 million of new hospital building.

Command Paper 4234 is questionable in its strategic results in terms of what it postulated for increases in spending. It does not postulate a rise in spending on the social services over all, but it postulates a basic crisis in that the community must decide how it is to achieve additional receipts in order to create additional spending on special categories of need. This is a question of savings, efficiency and productivity in the Health Service, referred to on page 53 of the previous Government's Command Paper. I hope that this new Government will tackle it with energy.

I want finally to suggest, tentatively and humbly, a number of ways in which we could decide on priorities for the future. First, the local authorities' care services need to be encouraged a good deal more. Here I pay tribute not only to the London Borough of Harrow as an outstanding local authority in this respect, but to other local authorities as well. The emphasis will need to be greater in the future. The rate support grant system will need to be looked at in a fundamental way when the new Administration has the time to slot it into their lengthy and exhaustive programme. Secondly, we need to boost integrated hospitals, and I have referred already to the Northwick Park Hospital. Thirdly, I do not think that the organisational reconstruction outlined in the Green Paper was a partisan issue and, therefore, subject to details, I imagine that the present Administration will give some thought to reconstructing and co-ordinating the services. Finally, while universality has been a great servant of the country in the past, at the margin, there may be cases where it is not applicable. Unfortunately, there has been a curious paradox in the past that the universal basis of providing social services has enhanced the inequality of the services provided and the treatment received by different people. There will always be people who, despite a heavy tax burden, have little confidence in the quality of the services provided and decide to finance them themselves. That means that the national services may be deficient, in the sense of the pressure of demand on limited resources.

I am very grateful for the indulgence of the House. I thank hon. Members for listening to me, and I hope to have the opportunity of speaking again at a later stage.

5.28 p.m.

Mr. Christopher Mayhew (Woolwich, East)

The House has been delighted to listen to two maiden speeches, both excellent, but completely contrasted in their style. The hon. Member for Harrow, East (Mr. Dykes) made a maiden speech in what I would call the traditional style. The style was universal when I was a boy and first came into the House in 1945. It was scrupulously polite, modest and, though not wholly uncontroversial, certainly uncontentious. It contained those references to one's constituency which look so well in the local papers and help to consolidate one's recent and perhaps precarious election victory.

My hon. Friend the Member for Bedwellty (Mr. Kinnock) made a maiden speech in what I would call the modern form. It was made with the fluency, confidence and aggressiveness which we older hon. Members have been trying, without success, to cultivate over the years. The House will wish me to congratulate both maiden speakers warmly and to say that we look forward to hearing from them again.

I want to make only one point in this debate, because I want to question the degree of priority and attention given by both Front Benches, both political parties and the public to the problems of mental sickness and mental handicap as against other health matters with which we in this House have to deal.

Starting with my right hon. and hon. Friends on the Opposition Front Bench, I draw their attention to the fact that their Motion makes no reference to this subject. In her speech, which in many respects was admirable, my right hon. Friend the Member for Blackburn (Mrs. Castle) on only two occasions made reference in a brief and incidental way to the whole subject of mental health, mental sickness and mental handicap. In the Queen's Speech there is no reference to the health services, let alone the subjects of mental sickness and mental handicap.

There was one passage in the Minister's speech which related to mental handicap, but it was not clear what, in concrete terms, was meant. The Minister congratulated his predecessor, my right hon. Friend the Member for Coventry, East (Mr. Crossman), on something that he had done or was about to do for the mentally handicapped, but it was not clear to what the Minister committed himself. He did not say which part of my right hon. Friend's plans he had been studying or which part he agreed with and proposed to accept. The only reference that he made was that no extra expenditure would be incurred by whatever it was that he might decide to do.

As long as I have been in this House I have noticed a strange paradox: the degree of neglect or lack of priority given to what is, looking at our problems with a clear eye, our biggest social problem. It is the biggest because it is the most widespread, because the degree of hardship involved is the greatest, and because its cost to the country is the greatest.

The extent is well-known. There are almost 200,000 patients in mental and mental subnormality hospitals. In addition, there are almost 200,000 patients in touch with local authority services for mental handicap or mental sickness of some kind. That is 400,000 people, which is only the hard core of the problem, only the tip of the iceberg, because beyond those 400,000 suffering people are those who are not in hospital, not in touch with local authorities, but who consult their G.P.s for some psychological or psychiatric reason. Beyond them I am sure there is a large number of people who no doubt should be consulting their G.P.s, but do not do so because they are shy or do not know about the problem. Altogether, on the most conservative estimate, I should say that the number of people suffering from mental sickness or mental handicap, together with their families, is an army of not less than 2 million.

I do not need to tell the House what degree of suffering is the worst. We have only to ask ourselves which we would rather be. We would rather be unemployed, homeless or physically handicapped than mentally sick or mentally handicapped. We have only to go round a mental hospital, a junior training centre, or have a friend or relation who is the parent of a mentally-handicapped child or is himself or herself mentally sick to realise that. The smallest personal acquaintance with this handicap proves that, though there are other great hardships of homelessness, unemployment, ment, poverty and physical sickness, if given the choice the last thing that we would be is mentally sick or mentally handicapped.

Let us consider the cost to the community in sickness benefit, supplementary benefit, the cost in terms of hospitals, G.P.s, research, and man-days lost in industry. The last figures that I saw were quite fantastic. They showed that in 1968 2 million days were lost in labour disputes, 5 million days were lost through colds and flu, and 29 million days were lost through mental sickness.

If we look at our problems with a clear eye, I suggest that we must come to the conclusion that mental sickness and mental handicap is probably the greatest single obstacle to human well-being in this country. Yet—this is my point—when we look at the parties' election manifestos—which the Minister flourished before us today to tell us how many lines were devoted to the Health Service—I think he said that there were 40 lines in the Conservative manifesto devoted to the Health Service—we find one-half of one line in the Conservative Manifesto, two lines in the Labour manifesto—less than 1 per cent.—and in the Liberal manifesto, which is called "Care", no reference to our greatest social problem at all.

Never before at a General Election has so much been talked about compassion. We are politicians. I have been in this House for a long time. My judgment is that Members of Parliament are more compassionate than most, but the compassion which was talked about at the General Election was misdirected, because, as the manifestos, the speeches and the broadcasts showed, it was not related to the most neglected and distressed section of the British people—the mentally sick, the mentally handicapped, and their families.

This afternoon, apart from a small reference by the Minister, there was no reference to this problem at all. I tell my right hon. Friend who is to wind up the debate for the Opposition that he cannot take for granted our support of the kind of Motion that is on the Order Paper which refers to a number of aspects of the Health Service but does not refer to this aspect. I have drawn this matter to the attention of my right hon. Friends before. If they do not take any notice, they cannot expect me, anyhow, to support them on a Motion of this kind. Perhaps my right hon. Friend, when he winds up, will explain why there is no reference to it. There is a reference to hospitals, but that excludes reference to mental hospitals and mental subnormality hospitals. The Motion speaks of the "expanding programme of hospital building". But we want to close down and get people out of the mental subnormality and psychiatric hospitals. Why is there no reference to that? Why was there no reference by my right hon. Friend the Member for Blackburn to these important matters?

I am not getting at my Front Bench to the exclusion of the Government Front Bench. All the parties are as bad as each other. It has been the case for years. We are all brainwashed, it seems, by the materialist assumptions of our society, concentrating on the physical wellbeing of people. We forget the great paradox facing us, which is that we British are better off, better housed, better educated and better in physical health than ever before, but at the same time we have in our society more delinquency, more crime, more anxiety, more alcoholism, more drug addiction and more violence.

If we are in touch with the needs of the country, instead of repeating what we have seen in party manifestos over the last 20 years, these matters should be clear to us. But they are not reflected by either Front Bench or by current politics in this country. The result is that we have neglected this problem over the years. We have neglected psychiatric research in our mental and psychiatric hospitals. Today there is avoidable discomfort and indignity for many people in hospitals. We have overcrowded wards, too little nursing care, too little medical care and too few amenities. The overcrowded wards in our mental hospitals today are what the unemployment queues were in the 1930s, our greatest shame and challenge. But our politics do not yet reflect this.

What do we need? We need a better career structure for psychiatric research. Of all the things that we would want if any of our family or friends were mentally sick, would not be better conditions in hospitals, but to be cured. Even better, we would want the handicap or the sickness to be prevented. This can only be done by more knowledge and more research. We will get the solutions one day to these great mental sicknesses.

Dr. Miller

I am not at all unsympathetic—in fact, I am very sympathetic—to the view being expressed by my hon. Friend, but may I ask whether he realises that the occupancy rate in mental hospitals is lower now than it ever was? Many more people have been discharged. My hon. Friend is talking generally about the problem associated with old age. This is a matter with which our society is very much concerned.

Mr. Mayhew

It is true that the present occupants of mental hospitals are, to a high degree, old people. But the faster rate of discharge from hospitals is paralleled by an increased rate of re-admission. We have a greater turnover in the hospitals. There is no evidence that there is a falling off in the number of people who are mentally sick. I know that my hon. Friend will agree when I stress the need for more psychiatric research. We will get on top of these illnesses one day. That day will come quicker the more head of steam we get behind it now. People say that we do not have the men, the scientists and the ideas for research, and it is therefore no good making more money available. I contest that completely. I think that we could do more now if we had more money. One has only to look at the excellent work done by the Mental Health Research Fund. No one can tell me that the money it spends is wasted, or that it could not spend more money profitably.

The fact is that we shall not get new ideas and brilliant new men into psychiatric research unless we create the climate, the career structure, the fellowships, and the long-term well-paid research openings for them. That is what we need so that we can get the most brilliant of our young men and women to take it for granted that the finest career ahead of them would be to get on top of some of these mental illnesses. That is one of the things that can and should be done. There should be more finance, and more administrative support for psychiatric research.

Mr. Laurence Pavitt (Willesden, West)

I accept my hon. Friend's argument, but will he accept that the Medical Research Council is now spending £17 million a year and that a high priority is given to psychology, psychiatry and neurology, and that a team of devoted people are doing good work?

Mr. Mayhew

I accept that there has been a great improvement, but I believe that only about 12 per cent. of the medical research budget is devoted to psychiatric illnesses. The figure has increased fourfold in the last 10 years but, seen in relation to the need, to the number of people affected, and to the possibilities, I do not believe that it is a very large sum. I do not consider it sufficient.

We have discussed at great length some of the other urgent action that needs to be taken, particularly with regard to community care for the mentally sick and handicapped, and I shall not spell it out now. It is a familiar subject. We know that it needs to be done. We know that it will take a lot of money. One of the things that was wrong with the Mental Health Act of 1959—a splendid Act which has done a great deal of good—was that it never made the requirement for local authorities to provide community care for the mentally sick mandatory. That was a great failing, and I hope and believe that the Government will press strongly for and facilitate the provision of community care of all kinds, primarily by local authorities, so that people who are in hospital and who ought not to be there—they are there not for treatment, or for hospital care, but simply and solely because there is nowhere else for them to go—can come out into the community and live in sheltered flats, or homes or hostels. A whole range of alternative provision needs to be made to fit each category. This is a practical idea. We know how to do it. It is done in many cases. Something is being done, but we need a great deal more urgency about it.

To sum up, I urge my right hon. Friends and also right hon. Gentlemen opposite to try to give the whole question of the health of our minds in the 'seventies a greater priority than it has had so far. This is a more important question than the prescription charges which we have talked about at some length, and about which we quarrel year after year. It is a matter which deserves to be ranked with housing and with pensions themselves. In terms of the welfare of our people this is our greatest challenge in the 'seventies, and I hope that this will be an epoch-making parliament in giving the righ priorities and values to the subject of mental health.

5.44 p.m.

Miss Mervyn Pike (Melton)

I am sure that the whole House enjoyed the speech of the hon. Member for Woolwich, East (Mr. Mayhew). I hope that the hon. Gentleman will forgive me if I do not follow him, much as I should like to do so.

I started my social work nearly 20 years ago in mental hospitals, and my voluntary work outside the House is concerned with mental health, but I do not wish to pursue that subject too precisely this afternoon because there are other things that are important. I hope, however, that when I am talking about setting priorities the hon. Gentleman will accept from me that I believe that one of the highest priorities in our health service should be research and rehabilitation in the community of those who are suffering mental handicaps in one way or another.

I express my pride and pleasure in the fact that we now have in charge of this great subject and this great Department my right hon. Friend the Member for Leeds, North-East (Sir K. Joseph). He, perhaps more than anybody else, brings to it a quality of compassion—an overworked word—humanity, thoughtfulness and kindliness, as well as the wisdom and expertise, that are so necessary. I express my pride and pleasure in his team, too. Many of us sat for long sittings considering the Pensions Bill introduced by the previous Government, at which there was present my hon. Friend the Member for Somerset, North (Mr. Dean). We know that he is a man of great capacity, patience and wisdom, and we therefore look forward to a new Pensions Bill being steered through the House under his leadership.

I am particularly glad that my hon. Friend the Member for Barkston Ash (Mr. Alison) is looking after health matters. I started my local authority work, as well as cutting my political teeth, in Barkston Ash. I gained my practical experience in health and welfare work at local authority level in his constituency. I therefore know some of the problems which he knows at first hand. We are glad that he is in charge of this subject, and I was particularly glad to hear from my right hon. Friend that he proposed to put him in charge of volunteers in the health field.

I pay my respects to the two hon. Members who have made their maiden speeches and escaped from the Chamber. The hon. Member for Bedwellty (Mr. Kinnock) spoke with vigour and enthusiasm about compassion. I believe that when he has been longer in the House he will recognise that compassion is not something that is confined to political argument. Compassion is something that we have to learn in judging our own actions in this House, and also I believe, like the hon. Member for Woolwich, East, that when we talk about compassion we have to be particularly hard-headed about what we mean. We have to think through carefully the things that we want to do. I appreciated, too, the speech of my hon. Friend the hon. Member for Harrow, East (Mr. Dykes) who was thoughtful and informative.

One of the things that I want to say in this debate is in criticism of us in this House. Those hon. Members who have been in the House for some time know that I have been absent from many of our health service debates. This has been due not to any will of my own but partly because, through no desire of my own, I have been studying the health service at close range. I can tell hon. Members that if they want a good cure for arthritis, an open-air election campaign in the sun followed by a Conservative victory is as good as almost any doctor's medicine.

Mr. George Thomas (Cardiff, West)

A terrible price to pay.

Miss Pike

One reason why I have absented myself from debates during the past months is the fact that, like many others, I have been concerned that in our social service and welfare debates in the House we have been warm hearted and well intentioned but we have not raised the level of the debates to the level that most of us would wish them to attain. I think that debates on this subject should achieve the level of the best finance debates in the House. I am glad that the Minister of State at the Treasury is present today. I believe that in studying the problem and in tackling it we ought to combine warm hearts with good intentions, because here we are at the heart of our economic problems and our economic battles.

The right hon. Lady the Member for Blackburn (Mrs. Castle) was full of fire and fury but also of sincerity. Her concern, as much as ours, is with tackling inflation, and if we are to be compassionate we must tackle inflation. When I talk about compassion, I have in mind all the things that roaring inflation has meant to the people of this country. Thus, when we are discussing these problems, let us not talk only about the things we want to do and about our good intentions; let us see how we can bring far more expertise into this subject.

That is why I am glad that we are to have Tory measures under my right hon. Friend the Member for Leeds, North-East, because he will bring just that very quality in his decision-making. When setting our priorities and deciding what we want to do in spending the tremendous sums which have to be spent in health and welfare, whether the money comes from public or private sources, let us use the most modern techniques in the decision-making.

I have been very fortunate during the past two years. I have been concerning myself with econometric techniques, which sound complicated and, I must admit, are difficult for somebody like myself who took a degree before the war. All these techniques are a new language. I am no hard-nosed technocrat who thinks that everything can be done by new methods and techniques, but if I have been able to learn the ways of assessing these things and to learn the language of the new technology, I reckon that almost anybody can learn it. If I have been able to see the use and value of these techniques, I would say that they are not above the capacity of any hon. Member.

I ask my right hon. Friend the Secretary of State, in looking forward to the future, to make sure that we use everything we possibly can, including econometric simulation models, linear programming techniques and all the rest. Let us make sure that not only the Government have this knowledge, but that the Opposition have it also. One of the great difficulties, as we know so well, having been in Opposition, is to get the true facts and the statistical data. All these new techniques and methods have to be used with great reservation. They are like the new wonder drugs in medicine. They can do wonderful things in the right and sensitive hands of those who know the pitfalls and the side effects and can make the right judgments. Equally, however, in the wrong hands they can give rise to tragic and drastic conclusions. Unless we have these things, unless both sides of the House are able to use these methods of assessing the priorities and the quality of decision that is made, I do not think that we shall ever be able to address ourselves properly to this problem.

I hope, therefore, that all the work we have done in Opposition will not be wasted and that it will be used not only for the benefit of the Government and those of us on these benches, but for the benefit of everybody who is trying to make the right sort of judgments in these matters, and not only for us in this country.

A fortnight ago, I was lucky enough to be able to have over here people from America and from Europe, people of liberal views in health and welfare, who were trying to get an interchange of ideas and experience in how we set up our health services and how we approached this great, fundamental problem in our society. As usual, the one thing that we found was that our data were insufficient or that a real interchange of argument was not possible. If we are to get the right solution, if we are to tackle the problem properly, we must see not only that we get it right for ourselves here but that we are able to get a good interchange between people in other parts of the world.

Every modern, forward-looking society is tackling this same problem of how to get sufficient resources into health and welfare services and how so to build the welfare services in those countries that they are an adjunct to and not a continual drain on a country's economic resources.

I have probably gone on long enough about my hobby horse of new techniques, but I would add that in doing this sort of thing one learns a discipline in approaching and assembling facts. These new techniques may not be all that useful in themselves, they may be too far ahead for everyday application, but the very fact of having to get the data and the statistics together is a discipline that we all need.

Not only, however, must we see to the setting of priorities and the quality of our decision-making. At the end of the day, the quality of the decision-making will be only as high as the quality of the person making that decision. Not only must we do that, but we must make certain that we use our resources to the full.

My other great concern is the place and use of volunteers in our health and welfare services. This is not a debate on volunteers, but I hope that we shall fairly soon have a debate on volunteers and their use in the community as a whole, because it is important that we get volunteers into these services not only because of the needs of the services themselves, but because as a community we need to increase and to encourage the volunteer spirit in our society. If we are to strengthen society, if we are to have a society in which we are proud to live and which we are proud to hand on, we must have a society in which the volunteer is encouraged and has a useful and important part to play.

Today, however, we are discussing the Health Service, and I want to say one or two things about the place and the use of volunteers in that service. I do not need to spell out that none of us in this House wants to use volunteers as cheap labour or as an alternative to skilled people. Most of us recognise the importance of the place that volunteers can fill, although we recognise that they save money and give of their resources and their skills without any drain on the community. The important thing which they do is to give an extra dimension to the service which no amount of money or resource can put into the service. It is not just the quality of the service they give, important although that is, but they come into the service with critical eyes. They come into it more and more from an educated, specialist background and they look with new eyes at the things they are asked to do, the resources and the structure around them. They can give this extra dimension and they can give an extra quality to the service.

That is why we want to ensure that in our health services, in particular, we get volunteers of every type and every calibre. We do not want only people carrying soup and doing the chores. We want to make it possible for people to bring their own skills which they have had in their own lives, in the universities or in business. It should not be beyond the wit of a society like ours so to organise our services that we can use those skills in a volunteer capacity.

Equally, they bring a special quality of humanity because they are not having to live 24 hours a day in the service, because they can bring a freshness and a humanity, whereas those who are working there all the time, because of the very necessity of the work they are doing, must to some extent be dulled or disciplined so that they do not bring the sparkle, as it were, or the special quality that the volunteer can bring.

We want to make certain in this context that more younger people are enabled to come into our service and learn about life in this way. C.S.V. and similar organisations are not only doing a tremendous amount for mental health in mental and other hospitals, but are doing a lot for the young people also who go into those hospitals, so that when they go forward into life they are determined to make certain that they tackle these problems and get the skills which will enable them to serve people in these circumstances.

Equally, however, where we get the volunteer, we get the voice of the consumer, because the volunteer goes into a situation and feels, "There, but for the grace of God, go I." Very often the people who are being served by the health and welfare services are not articulate or able to make their needs known. Very often they are not able to make their complaints known. The more that we get volunteers, particularly in mental hospitals, and the more we bring in the world outside, the more we shall get the voice of the consumer who asks why our standards are so low and why we cannot have better resources and better services.

This is where we can combat the fear that is in all our minds about two standards in the Service. We talk a lot about this. I am in the B.U.P.A. scheme and I have been very grateful for it in the last few months because, as a result, I have been able to have a private room in a hospital, keep on with my work and get the best treatment. I have been part of the two-class treatment system. I do not want that. I want everyone to have the same sort of treatment. But I am realistic enough—

Mr. Will Griffiths (Manchester, Exchange)

How do we do that?

Miss Pike

By getting more and more resources into the Service. I have no doubt, for instance, that any hon. Member here will have first-class service as against, in some cases, second-class service outside. We must get away from that. I believe that bringing more and more volunteers into the Service and making certain that more and more people see the kind of treatment that the ordinary patient, who cannot claim any privilege—

Mr. Griffiths

The hon. Lady has been talking for a long time about the rôle of volunteers. We all know that, as hospital friends, and so on, they do very useful work, and I am all for it. But would the hon. Lady go into a little more detail of how she sees the rôle of the volunteers, and their limited function? For instance, can she see volunteers in the path. lab., or in the physiotherapy department or the nursing department? It is not as simple as all that.

Miss Pike

I agree that it certainly is not simple. I only wish that this were a debate on volunteers because I could then speak at length on the subject. The volunteer cannot go into the path. lab., of course, but there is no reason why someone working there should not also work as a volunteer in a different part of the hospital. I do not say that we can put volunteers into technical and specialised jobs, but if every type of person is able to work across the Service one gets inter change, cross-fertilisation, and an articulate pressure for an increase in standards. The more we get outside people coming in so that they see the lamentably low standards in some parts of the Service, the more will be the pressure to get those standards raised.

I agree with a lot that Professor Townsend said in his New Fabian pamphlet. I have not had the time yet to read that pamphlet all that carefully, but it is not unusual for me to agree with many of his views. There is a great opportunity for us to have a community-orientated framework in the health and welfare services. We must be careful not to compartmentalise either our voluntary work or our approach to it in any aspect of our planning.

I want to make certain that the community is involved as closely as possible. That is why I believe that it would be useful if the Minister were to require the local community, the local authority, to draw up a profile of the community—a scenario, a plan, call it what one will—showing the community objectives: the type of services it wants; the identification of need within the community; the delineation of the problem in the community as a whole; the assessment and allocation of resources.

I should like to see that done on a scientific basis. It is done in Detroit, in California and in other places with tremendous community problems which cut across departments and involve the whole width of responsibility in a local authority area. One must build up this profile for the use of the officials in the local authority, the Ministry or Government Departments as a whole, and also in order to make sure that the public can see what the pattern of their community is, and know the problem, the resources and the needs. In this way we could get a public awareness, and a public assessment of how and where their money should be spent.

We must get a lot more money and other resources into the health and welfare services. In these services I want to see as much private provision as possible, because it is part of my ideology that that brings in greater responsibility, and enables us to expand the services more fully. But we should not be tripped up on ideology. One of the greatest mistakes is to approach the whole area with too close an ideology. My basic ideology is that we must bring aid to those who need it, and that wherever there is a need in our society, it is met. That is my basic ideology, and I shall not be tripped up by any other type of approach—

Mr. Kenneth Lomas (Huddersfield, West)

I fail to understand the hon. Lady's argument. First she speaks of this one-nation idea, but in the next breath she speaks of a privileged class and of treatment that the ordinary individual in the street cannot afford. Those who do not have the money get second-class treatment, but they can have first-class treatment if they can pay. That is an ideology that I and, I am quite certain, every hon. Member on this side refuses to accept at any price.

Miss Pike

It is very easy for the hon. Member to construe my words in that way. It is, after all, the basis of all our political arguments. I do not want to see two classes, but I am sure that if the hon. Member, unhappily, were taken ill in the Chamber, he would have provision made for him which the ordinary person outside would not get. I believe that people who can pay should be required to pay. I am well able, in my present circumstances and with no dependants, to pay for quite a large part—

Mr. George Thomas

But surely the hon. Lady does pay. We pay according to our tax assessment. The more we have, the more we pay, and it is only right and proper that it should be so.

Miss Pike

The right hon. Gentleman and I have had many arguments on this, and we understand each other very well indeed. I have stupidly allowed myself to be drawn into this argument—

Dr. Miller

The hon. Lady is falling into the fallacy into which many fall when they think that they are able to pay what they consider to be, for example, a few £s, or perhaps pay for a room. But the hon. Lady is relying on the National Health Service itself, because were it not for that Service she would not be able to pay. She would have to be a millionairess to pay for the things people get under the National Health Service.

Miss Pike

Yes, and I want to see the Health Service maintained and expanded. I have always fought hard for that. What I am saying is that I am not ideologically opposed to any form of private payment in it. I want to see the Service expanded—hon. Members know that I do. They know, that I am one of its great supporters. At the same time, I am not opposed to bringing in private provision where I think it can be to the advantage of the Service as a whole.

I want us to ensure that when we talk about humanity and compassion we do not think just in terms of riding off on a policy of being warm-hearted and well intentioned. We must use every possible modern technique of assessment and decision-making to get our priorities right. Every hon. Member is realistic enough to know that we shall never have all the resources we want to do everything that is necessary in the National Health Service. We must, therefore, have the right judgments.

I appeal to my right hon. Friend to make an advance in the social service sector, with open decision-making, so that hon. Members on both sides have easy access to all the statistics, data and other material that is necessary for a proper consideration of this issue. In this way we may raise the level of these debates, getting away from the easy political points that are so often made and getting down to some of the hard "nitty gritty", as the Americans say, points of argument.

I hope that we shall address ourselves to the best use of the resources that are available, remembering that the most valuable of all are the human resources; the volunteers who are prepared to give of their time and effort. I trust that my right hon. Friend will never forget that the community as a whole is probably the best unit from which to start a consideration of any of these aspects.

We must ensure that we have experimentation and cross-fertilisation, especially of new ideas. We need a new research unit at the Ministry to assess new ideas and, at local level, people must be informed of the problems, resources and needs, particularly of the local community. Then we may be able to generate an advance, in human terms. Let us never forget that we must do everything possible to bring in private resources, because it is clear that the public sector will never, by itself, provide for every facet of the social services and the National Health Service.

6.13 p.m.

Dr. Shirley Summerskill (Halifax)

I congratulate the hon. Lady the Member for Melton (Miss Pike) because, at least from her, we have heard something of the real philosophy of the Government. She referred to the "ideology" behind Conservative thinking on the National Health Service. The purpose of this debate from our point of view is to elicit information and to get answers to certain questions from the Government, because the electorate deserve to know these answers.

We looked in vain at the Gracious Speech for even a mention of the N.H.S. The Government owe it to the electorate, at the end of the debate if not at the beginning, to say exactly what their intentions are for the N.H.S. In the Gracious Speech we have proposals for local commercial radio and proposals to safeguard the beauty of the countryside, but not a word about our hospitals, local health services or the general practitioner.

During the election campaign hon. Gentlemen opposite effectively offered the electorate more money to keep in their pockets by tax cuts. That promise had simple appeal. It was easily understood and it was attractive to the voter. I believe, however, that it was an irresponsible appeal because nobody was told of the long-term price that would have to be paid if there were tax cuts; and today we want to know what that long-term price will be in terms of the N.H.S.

We put it to the Government that the price will have to be paid by certain sections of the community, particularly by the sick who are the least able to pay in time of need. Either provision under the N.H.S. will be cut or the sick will be made to pay.

What about educational provision? Is it to be cut as part of public expenditure cuts which will enable the Government to make reductions in taxation? What about nursery school, primary school and university provision? Do the Government still intend to raise the school-leaving age, with all that that involves? We want assurances on all these things, just as the pensioner wants to know how he will fare.

The right hon. Gentleman the present Secretary of State came to my constituency a few months ago and assured the people of Halifax that a Conservative Government would cut housing subsidies. I read the report of his speech carefully. What will be the effect of such a measure on council house rents? In the last Parliament I asked what would happen to council house rents in Halifax if housing subsidies were abolished. I was told that the average council house rent would go up by 16s. a week. What will happen under the Tories if this should come about?

There are many other benefits which we have taken for granted under Labour. What budget will be available to Ministers responsible for the arts, sport, recreation and leisure? How will all these be affected by the promised tax cuts which were put to the voter at the election and which will take £600 million out of the Exchequer if S.E.T. is abolished? It is thought that if direct taxation is cut, £1,000 million will be removed from the Exchequer. A further £300 million will be required if forces are to be returned east of Suez. Even the voters to whom these policies appealed at the election are saying, "We want your tax cuts, but we want to know the price we shall have to pay." The Government must explain.

If the social services are cut, three things will suffer. At present higher standards are expected, particularly in the N.H.S. More people are using the service and are benefiting from it. Much more than is available is needed in every department of the service. These three factors mean that no Government could maintain the N.H.S. at its present level of expenditure and fulfil the promises which hon. Gentlemen opposite have made.

Labour's record in the social services was not mentioned by my right hon. Friend in her opening speech, but it should be rubbed in. I challenge hon. Gentlemen opposite to say that they can keep to Labour's record. On education we spent 70 per cent. more than the Conservatives. On health and welfare we spent 69 per cent. more, on social security we spent 74 per cent. more and on housing, 70 per cent. more. Do the Government feel that they can keep up this rate of expenditure and at the same time spend more on education than on defence for the first time in our history?

Under Labour the cost of living may have gone up, but most people agree that the standard of living of most people in Britain is now higher than at any time, and this includes not only those with motor cars, holidays abroad and washing machines. The social services are available to the masses and these services are better than ever before as a result of six years of Labour Government. I hope that the Conservatives will keep up this level of expenditure.

Can the Conservative Government better a 10 per cent. real improvement in all pensions, two million new homes in the last five years, an increase of nearly a third in new school places, and the fact that in 1968 double the money was spent on hospital building as was spent in 1964? In my constituency during the period of Labour Government we have seen built a 114-bed maternity unit, a brand-new psychiatric unit of 60 beds, and a complete geriatric unit of 256 beds.

I should like to see the hospital building programme which is now in force, and which has been in force for all these years, maintained and improved under the present Government. We should have a definite assurance by the Minister at the end of the debate that this will continue and that they will not only match our record in the social services but will exceed it. The provision must increase since over the years the demand will increase.

There are six spheres of health activities in which more will have to be provided under the present Government than under the Labour Government. Mental health and care for the handicapped take priority. Kidney machines are an urgent necessity costing a great deal of money, and I do not see how more of these can be supplied if there are cuts in National Health Service expenditure.

What is the policy of the Conservative Government towards industrial health? Will provision be made to reduce accidents and illness at work, where we spend a third of our lives? There is no mention in the Queen's Speech of health centres, on which the Labour record is excellent. Since the end of 1964, 106 health centres have been opened, 90 are under construction, and 85 more have been approved. It is from these centres that the family doctor of the future will operate and the younger doctors are coming to accept health centres. There will no longer be the single-handed practice, or even a partnership or group practice. The health centre will be the basis of doctors in practice.

What are the aims of the Conservative Government in these matters? Will they keep up the record of the Labour Government? During the period of office of the Labour Government no single application for loan sanction for a viable health centre scheme was deferred. I hope that the same principle will apply under the present Government. There will also need to be an enormously increased expenditure in the care of the elderly over the next few years. We are living longer than ever before; the expectation of life is greater and will continue to increase. The old will need to be nursed at home far more than in hospital. We have the welfare services to look after and we need more meals on wheels and more day centres for old people.

This is the health service of the future. The Government cannot sit back and even maintain what Labour were spending on the health service. They must improve upon it and increase it. For some six years I listened carefully to speeches made by hon. Gentlemen opposite when in opposition about the National Health Service and tried to glean some idea of what their intentions would be when in Government. It was an extremely hard task since their speeches were shrouded in mystery. There were hints and innuendoes, but nothing definite was promised. Even in the Queen's Speech we heard nothing about this subject. We can only suspect that charges will move very much to the fore.

I appreciate that the record of the Labour Government on charges has been been far from blameless. I, like many of my colleagues on the back benches, opposed tooth and nail the introduction of prescription charges, and I still do to this day. I believe that Labour's manifesto should have said that when the economy was strengthened we should withdraw the charges. I believe that we opened the door to allow a Conservative Government to put on more charges. It ill becomes hon. Members from this side of the House to oppose charges unless they opposed them at the time they were put on by a Labour Government. But even the Labour Government would not have gone as far as to charge for general practitioners at night, for hospital meals and for long-stay patients in hospital. These are fundamental attacks on the scheme which it would be extremely difficult to justify.

Here again we are only supposing since we have no evidence of what the Government intend to do. But it is clear there will be a two-tier Health Service, one for those who can pay, as advocated by the hon. Lady the Member for Melton (Miss Pike)—

Miss Pike

I did not advocate a two-tier Health Service, one for those who pay and one for those who do not. All I said was that I was not against private provision being brought into our health and welfare service. I do not believe we can ever get enough money without some form of private provision being brought in.

Dr. Summerskill

I may be misunderstanding the hon. Lady, but it seems to me that that is a two-tier service. If under B.U.P.A. she can go into a hospital and have private treatment in a private room, that seems to be on one standard, whereas if somebody else has to be in a noisy ward, with people snoring and a lot of disturbance at night, that seems to be at another level. In my view that is two-tier service. The one costs a little more money to obtain and the other one gets as a taxpayer.

We have seen in the United States to what this type of service can lead once it begins to take root. Enormous expense is imposed upon people far beyond what an insurance scheme can cover. Of course they are insured, but if they have to go suddenly into a clinic for a major operation they can find that their insurance far from pays for that operation. It helps, but they suffer financially for many years.

There is evidence of this in a great many authorised documents and I should like to quote what was said by an American doctor speaking of the situation in the United States: Half of all Americans do not even have their own doctor. Almost nobody can afford to have a serious illness. Life expectancy is shorter by up to 20 years in America than it is in parts of Western Europe. We can only paint a picture of what we think will happen under the National Health Service during the period of office of the Conservative Government. An increase in private hospital beds was advocated by the hon. Lady the Member for Melton. I should like to know whether the Government support the hope expressed by the hon. Lady or whether they will deny that private hospital beds will be increased in number. What will happen to the proportion of gross national product which is spent on health? Under Labour it has risen since 1964 from 4.2 per cent. to 5 per cent. Will this figure be improved upon?

Part of the expense of the service depends on efficiency. What are the Government's intentions about the tripartite structure of the service and the recent Green Paper? Do they intend to implement the Green Paper later, since an efficient Health Service would give value for money.

I urge the hon. Gentleman in his reply to give the people of Britain an answer to the most important questions which have been posed in this debate. To what extent will selectivity in the social services operate under the present Government? We were spending more than 75 per cent. on all social services than did the Conservatives in their last year of office. Will this amount be maintained and increased?

We heard much during the General Election from Conservatives about freedom of the individual, that we should stand on our own feet and make our way in the world. We believe that the sick are not able to stand on their own feet and to make their way in the world. Under a Conservative Government it can be said that the price of a welfare state is eternal vigilance.

6.31 p.m.

Mr. Patrick Cormack (Cannock)

Thank you, Mr. Deputy Speaker, for calling me. You have given me something of an intimidating task, because not only do I follow two hon. Ladies in the debate and cannot compete with them for grace and dignity, but I also stand behind two colleagues from the medical profession.

I think it appropriate that I should follow two hon. Ladies because I have succeeded the right hon. Lady the ex-Member for Cannock. This is a great honour and I am glad to begin in the traditional way by paying tribute to my predecessor, a lady who was a great servant of her party and who was, and still is, held in high regard throughout the country. I feel it a great privilege and honour that I have been done by the electors of Cannock in being chosen to succeed her.

My constituency is one of those very large constituencies which might not have been there but for certain actions in the past. It is a constituency which has over 90,000 electors. It is based on the mining town of Cannock, although that has changed much in recent years, and it includes a vast and beautiful rural area. It also includes part of the County Borough of Wolverhampton. It is a constituency which has many problems. I particularly wanted to speak in this debate because so many of our problems are concerned with provision of health and hospital services.

To this area over the last few years many young people have come to work. Many have come from the great cities of the Midlands and the North and from places where the amenities and facilities, cultural, educational and recreational, are much better than we can offer in Cannock. Most of them have come from areas where hospital facilities put ours to shame.

We are part of the mid-Staffordshire district. This district has a population of upwards of a quarter of a million, but we have only 839 non-psychiatric beds. Since the National Health Service began we have had less capital allocation per head than any other part of the Birmingham region, and that region itself has been something of a poor relation. In Cannock, a town which is the centre of a district with 100,000 or more people, there are no accident facilities and no out-patient facilities. There are 18 maternity beds and inadequate geriatric facilities housed in an old workhouse.

I do not apologise for referring at length to the problems of my constituency because I know they are typical of the problems which many hon. Members on both sides of the House have. They are particularly typical of the problems which those of us face representing constituencies which contributed so much in the past to this country's industrial greatness. These areas have served Britain well but in recent years they have been sadly neglected by successive Governments of both parties. If I can do anything to prompt my party to look at the needs of my area I shall feel that my election was not in vain.

The problems are, of course, legion. I believe that it is the duty of those of us who sit in this place to try if we can to offer some suggested solutions. Of course, the long-term problem is that we should always endeavour to remember that prevention is better than cure even if it is infinitely duller. We should be trying through the medium of the Health Service to create a situation in which fewer people need to go to hospital.

That is why I was so glad when my right hon. Friend referred to home treatment, because so often domiciliary care is the real answer. So often, even at the moment, hospital beds are used unnecessarily. Very often, too, there is not enough liaison between consultants and the local medical officer of health and the staffs under his direction and command.

It is ludicrous, for example, that so many people have to go to hospital to have stitches taken out. This is the sort of human problem we should look at, but it is only one side of the picture. We are still faced with grave difficulties in places like Cannock where there is a shortage of hospital beds and where a crash programme is necessary. It is no use anyone saying that this cannot be done. After all, when a building is in danger of collapse we shore it up. That is what we have to do to the National Health Service as it applies to many hospitals.

The answer lies in meeting the twin challenge of time and cost. That, I suggest, can often effectively be met by considering the possibilities of prefabrication. In Stafford we have a vast hospital, St. George's. It is a psychiatric hospital, and many patients there, who are my constituents, have been there for many years. Two years ago that hospital had a 40-bed prefabricated ward built in the grounds. It is entirely self-contained with all the proper facilities and extra day space for the patients. The cost of that 40-bed unit, including all the furniture and even the television set, was under £30,000. The time taken in the middle of winter to build it was 11 weeks.

If that had been a traditional unit, not only would it have taken infinitely longer to build but it would have cost at least £80,000. It seems that the cost per head when considering expansion is about £2,000, and when we are talking of a new general hospital, including all the facilities necessary for it to work, it comes out at nearer £10,000.

I am not suggesting that prefabricated buildings are the solution to all hospital problems, but they could solve some of the problems in the Cannock constituency and no doubt in the constituencies of many hon. Members present tonight. It is no use saying that because one cannot afford a Rolls Royce one cannot have a motor car. I should like to see the maternity problems tackled in Cannock in this way. We could have a 40-bed G.P. unit—and there is still a place for the G.P. unit—for about £50,000. That would include all the theatre facilities and would be about a third of the cost of a traditional building, yet it would take far less than a third of the time to erect.

There is an added advantage in all this. The life span of a prefabricated unit is about 30 years, but ought we to build for longer than that? When considering the changing needs and standards of medicine we do not want monuments to twentieth century architecture, which has little to commend it, but effective hospitals. If we just build vast new district hospitals—although some of them are necessary and I shall mention one—in some cases we shall be creating what in 25 or 30 years time will be obsolete embarrassments. I hope that the Secretary of State will consider these things both on a national level and also as they concern my constituency.

I hope that my right hon. Friend will not think that what I have said is in any way meant to suggest that we do not need a new district general hospital in Stafford, for we do, but I hope that he will give urgent and early consideration to the problems of my constituency and those of other hon. Members which must have similar constituency problems to mine.

I hope that my right hon. Friend will take note—I am sure that he will—of the recent statement by the right hon. Member for Coventry, East (Mr. Crossman), who I am sorry to see is not here now. The right hon. Gentleman said that people are prepared to subscribe more for their own personal family security than they would ever be willing to pay in taxes. This was a perceptive observation. The right hon. Gentleman often makes perceptive observations. We on this side welcome it, because we strongly believe that it is necessary to give greater encouragement to private schemes if only to take the heat off the National Health Service at a critical time.

I hope, above all, that we can take out of this tremendously difficult problem the bitterness and sectarian strife which have tended to creep into the debate far too often this afternoon. We on this side may differ in ideology and in approach from hon. Members opposite, but we are just as concerned as they are about the nation's health and welfare. It is nonsense and hypocritical of hon. Members opposite to suggest, as some of them have done by implication and some rather more directly, that we are attempting to create a service which will be good for the privileged few and bad for the many.

Surely all men and women of good will, particularly hon. Members, can give a lead and show that the nation's health is the concern of us all and that we all of us in our own ways are determined to do what we can to rectify the situation where it needs rectifying and to maintain excellence where excellence exists.

6.41 p.m.

Dr. David Owen (Plymouth, Sutton)

I am sure that it is the wish of the whole House that I should congratulate the hon. Member for Cannock (Mr. Cormack) on an excellent maiden speech. The hon. Gentleman spoke with extreme fluency. He spoke about his constituency with understanding and thought and he chose a subject which is of great interest to his constituents.

The hon. Gentleman also paid a generous tribute to his predecessor. Miss Jennie Lee was admired and loved on both sides of the House. She made a genuine and lasting contribution in the House. It is, perhaps, apt that the hon. Gentleman should have chosen the subject of the National Health Service, the chief architect of which was Miss Lee's husband, as the subject of his maiden speech. The whole House will look forward to hearing the hon. Gentleman on future occasions.

I return to debates on the subject of the Health Service after an absence of two years. I confess to a feeling of sadness that many of the problems are much the same. For a time the Secretary of State was shadowing on this subject, and at that time the right hon. Gentleman and I were both advocating from different viewpoints the merging of the Ministries of Health and Social Security. It must be a great pleasure for the right hon. Gentleman now to be in charge of the merged Department.

I hope that the Secretary of State will follow the recommendations for which he previously argued relating to the Children's Department of the Home Office, which more logically comes under his present Department, and that he will follow up the recommendations he used to make when he advocated more research to be done into the workings of the Health Service. He advocated the setting up of a research unit and some form of inspection to ensure a more equal distribution of standards throughout the country, something which I think is still necessary.

I hope that the hon. Gentleman does all this also for the much more important reason that the provision of more information will only reinforce the need for more money, more expertise and greater efficiency in the conduct of the Health Service and the social security services that are a vital and integral part of it.

The right hon. Gentleman's speech, though thoughtful, was pretty bland. It contained little of the facts which we wanted to hear from him. The speeches so far have been wide ranging, but the right hon. Gentleman must recognise that there is deep anxiety on this side about what could happen to the Health Service. The Chancellor of the Exchequer has said, as have other Ministers in various speeches, both during the election campaign and since, that we must expect cuts in public expenditure. What causes many of us on this side considerable apprehension is that the National Health Service should be chosen for such cuts.

Very little on this came out of the Secretary of State's speech. He promised that the National Health Service would continue to be financed very largely out of taxation. We welcome that, but that does not go far. He announced an intention to improve the Service. We certainly welcome that.

One of the most worrying aspects of the right hon. Gentleman's speech was that where he dealt with the capital building programme. My hon. Friends have mentioned the real importance that we attach to continuing the very extensive growth in hospital building that was undertaken under the Labour Government. The most that the right hon. Gentleman would say on this was that he needed time to consider the capital building programme and had some doubts about the size of hospital building.

If we are to give the right hon. Gentleman time to study the capital building programme, which is a fair request for him to make, he must understand that we ask in return that he does not make in the short term massive or major changes in the capital building programme. If he asks for time to study it, he must ask from the Chancellor and the other Treasury Ministers time to look at it. The programme has been well researched. To some extent it was set in motion by the previous Conservative Government. We on this side attach considerable importance to it.

We shall not expect from this measured government that we have been promised—the new style government—radical or sudden cuts. The right hon. Gentleman himself, with his experience in the building industry, knows how detrimental short-term cuts can be in a long-term building programme. I hope that I have said enough to indicate to the right hon. Gentleman that we shall judge him from now more and more on his record.

Much though I should have wished to do so, I shall not follow my hon. Friend the Member for Woolwich, East (Mr. Mayhew) on the subject of mental health. I think that my hon. Friend draws a slightly wrong conclusion in thinking that people's concern about a subject must be judged by the amount of time that they have devoted to it in speeches or in their writings. There are other equally important criteria.

I shall devote my speech to an equally important aspect, namely, the financial aspect of the National Health Service. Between 1963–64 and 1967–68 the percentage increase in real terms in the expenditure on health and welfare was 23 per cent. This was less than the percentage increase for education, which was 26 per cent., less than the percentage increase for social security, which was 29 per cent., less than the percentage increase for child care, which was 31 per cent., and less than the percentage increase for housing, which was 42 per cent.

The one thing which seems to have come out of this debate is that everyone on both sides believes that there is a need for more resources in real terms to be put into health. I hope that hon. Members opposite will not escape on the ground of getting more value for money. Few people in the House have written more on the subject of getting greater value for money in the Health Service than I. I have given hostages to fortune in pamphlets and in books. It is a very important part of any changes that take place over the next few years to improve the efficiency of the Health Service and to improve its management. I do not believe, however, that any substantial contribution to finding extra resources can be made from existing resources. There is still a vital need actually to increase resources.

My hon. Friend the Member for Halifax (Dr. Summerskill) mentioned a number of specific areas where we shall have to have increased expenditure. Perhaps the most important factor is the demographic changes which will take place in the future. In 1969 Britain had about 8½ million elderly people. The number is expected to have increased to 9.2 million by 1975, reaching more than 14 per cent. of the whole population.

A youth explosion is occurring, too. In 1969, 12.8 million children were under 15. By 1975 there will be 14.7 million under 16, which is the age we shall have to get used to as being the new school-leaving age. It is therefore all too true that we shall have to run fast to keep still.

Between 1949 and 1956 the annual cost of a hospital bed rose by 209 per cent. while retail prices over the same period rose by only 84 per cent. This is a measure of the problem that faces us in the National Health Service on the allocation of resources.

If we look at the breakdown of expenditure in health and welfare and at the predictions for what will take place over the next few years, we find a situation where between 1968–69 and 1971–72 we are allowing for an annual average increase of only 3.8 per cent., whereas even on social security we were allowing on the public expenditure review figures an annual average increase of 5.1 per cent. There is clearly no fat on this public expenditure programme; in fact, I believe that there is need for even more resources than those which have already been allocated.

Looking at the breakdown, we find that 60 per cent. related to hospitals of which figure 70 per cent. represents the cost of staff. Taking 14 per cent. of the community health and welfare services, 50 per cent. of this is in providing homes for the elderly. We have accepted in this public expenditure prediction that the number of in-patients treated will continue to rise at the rate of 3 per cent. per annum. We have accepted that that increase can be offset by increased efficiency, so that the efficiency argument which I have mentioned is already taken care of, because we have a built-in commitment to increase efficiency, although I concede that we can do even better than that.

What are we to do about obtaining this extra finance? My hon. Friends have always believed that the best way of financing the Health Service is through taxation. We believe that this is the most progressive and the fairest system. Mention has been made of the fact that the Health Service takes 85½ per cent. of total taxation. However, I appreciate that with the present Government in power, there is little point in our talking about increased taxation.

The main point to which we shall have to draw attention is to direct the demand for extra finances into areas where this will do the least damage to the Health Service and to the fabric of the Service. This is where I come to the element of contributions in Health Service financing. At present they amount to 9½per cent. The amount of contributions made to Social Security is much higher. It is 28 per cent., 69 per cent. of which comes from central and local taxation. Social security is taking a higher measure of contributions, while the Health Service is taking a lower percentage of contributions. It is this element to which, in the need for additional resources, I hope the Government will direct their attention.

We also have to face how the contributions can be made fairer. The present flat-rate system of contributions cannot continue much longer. I believe that we have to move towards a graduated Health Service contribution, universal in its application, including married women, and graduated according to earnings. I know that some hon. Members opposite have a feeling against this, but when they were in opposition the present Chief Secretary to the Treasury said that the contributions could be an important element in the financing of the Health Service.

I want to deal with the key recommendations in the new comprehensive tome, Health Service Financing, produced by the British Medical Association's Advisory Committee. As my right hon. Friend the Member for Blackburn mentioned, it has to be taken seriously by those of us who are concerned about future trends because the present Solicitor-General was a signatory to that report. This recommendation of the advisory panel would mean in essence compulsory insurance, from which one could contract out into a voluntary scheme for extra benefits, or, in the last resort, one could return into it if the voluntary insurance rates rose at too high a level. Many claims are made for the advantages of this system, which is a tacit acceptance of a two-tier Health Service—and let us be quite clear about that: it was not ducked by the authors. The advantage claimed was that of tapping the pool of voluntary health insurance for the benefit of medical care. I think it is highly doubtful whether it would be to the benefit of medical care, but I will deal with that later.

Another advantage claimed was that it would release Government money tied up in the insurance category services. I do not believe that the present Government would dream of using this in addition to existing sources of finance. If they do introduce some compulsory insurance system and a voluntary insurance element in harness—a dual system—it will be to the expense of the existing Government finance which has gone into the Health Service. If they say that they would keep the present levels and add this on top, we might look at it, but the danger would be the same that it would be demanding a dual systetm. I have offered many hostages to fortune in the past, and on a number of occasions I have defended charges when I have not liked them because I have not been prepared to damage the fabric of the Health Service.

The interesting point about the report and the reason why we have to take it seriously is that it has rejected the view that contributions can have any major impact on Health Service finance. The authors refer to it as a useful adjunct, and they accept that it cannot make a substantial contribution to the revenue without making an intolerable barrier to treatment. The Minister himself drew attention to the fact that charges presented problems, such as the problem of creating exemptions and the low uptake of certain categories, and the whole problem of expending a very small amount of money for a very small return.

If we accept that contributions and charging will not be a very large element in the Health Service finances, we come back to the alternatives, and it is interesting to note that this group who presented the report should have rejected this as a method of financing the Health Service. It goes on to say that the prime reason that they introduced this form of dual system is that of introducing a measure of consumer choice. It says that it is The operation of consumer choice that we expect will provide most of the extra revenue. Hon. Members must face the fact that there are real objections to this scheme, and this is not some vague ideological argument. Let us examine some of the practicalities. What does "choice" mean in this context? Does it mean choice to nominate the doctor? This is usually one of the prime reasons why people join B.U.P.A. They nominate the doctor of their choice. They choose a highly specialised doctor who has scarce skills. They choose an eminent surgeon to do a varicose vein operation or a hernia operation. This is an extremely wasteful use of resources and it is one of the main, powerful arguments for not allowing consumer choice to operate in the Health Service.

It is often said, too, that it means a choice of the time and the place. One hon. Member who has spoken today on private medicine seemed to indicate that it was the ability to choose the time that one went into hospital and which hospital one should go to that was important. Does one choose that, irrespective of one's illness and irrespective of the severity of the illness? Under the present system, albeit that it is full of imperfections, as I would be the first to admit, the person who makes these choices on the type of doctor who is to do the operation or to give the treatment is the doctor himself. This is done on medical priorities. The people who decide who will come into hospital, the priority and where the treatment is to be given, and how, are the medical profession.

There may be imperfections, but are we to replace that choice with the almighty £ or dollar? There are places where the £ decides what is done, but if we allow this to happen in the Health Service where resources, hospitals, diagnostic equipment and, above all, manpower are scarce, it means that money rather than a person's medical condition will buy the appropriate medical care and priority. Right hon. and hon. Members simply must face that.

On the question of privacy, I have made no secret of my view that it is part of the job of the National Health Service to provide privacy for those who wish to have it and to pay for it, provided that it is not done to the prejudice of others in the care of the Service. I have urged many times that we should use the amenity bed more often and that we should charge a more realistic price for this facility. However, there is a crucial difference here. An amenity bed and the privacy which goes with it is available with the important proviso that, if someone else, because of his medical condition, must have that private bed because the doctor says so, that other person shall have it. There is no pre-emptive right to the amenity bed.

Some people going into hospital for a relatively minor operation, though an operation which may entail a fairly long stay, ought rightly to have privacy if they wish it and ought to be enabled to continue working in that way, and, if they are prepared to pay for it, this brings additional revenue to the Service. It is a useful addition to the finances of the Service, but it does not introduce any dual system and it does not threaten the all-important factor that the decision should rest mainly on medical priorities.

I could pose many more questions. It is sometimes said that the dual system would apply only to out-patient treatment, but we all realise that a distinction cannot be drawn between in-patient and out-patient treatment. More and more we are trying to ensure that, wherever possible, people who used to come in for in-patient treatment are now treated as out-patients or that the time spent in hospital is cut to the minimum. The questions raised depend just as much on, for example, a complicated test for insulin requirement, a complicated test involving radiography facilities, a complicated test even determining priority in out-patient operating time. All these raise problems which hon. Gentlemen opposite fail to recognise.

It is no accident that, when right hon. and hon. Members opposite were in government for 13 years, although they neglected the National Health Service they never basically challenged the fundamental concept of a universal Health Service. They made various attempts on the fringe, but that was all. What is worrying us now, however, and what this debate is all about, is the feeling that exists—it has been fed by various statements from influential hon. Members opposite—that they are about to challenge the whole structure of the Health Service. We warn them that there could be few actions having a more divisive effect on society.

If the Government want more resources for the Health Service and they put before us sensible proposals, I shall look at them and not automatically vote against any increase, whether an increase in contribution or a charge. But it is no use expecting us to accept at one and the same time a reduction in taxation and increased contributions or increased charges to make up for the reduced taxes. The present resources of the Health Service are inadequate and we want more. In my view, contributions offer a realistic way of making the additional resources available.

Right hon. and hon. Gentlemen opposite have, perhaps, a better opportunity than we might have had if we were in government. It is difficult to tell, but from the comments and whole approach of my right hon. Friend the Member for Coventry, East (Mr. Crossman) towards increasing contributions for the Health Service and making them earnings-related, I take it that we were prepared to look at this question seriously, while at the same time intending to introduce a compulsory earnings-related pension scheme. It is no good burking the point that to have the two coming at the same time would have created a severe individual load. The Government, however, so we gather, do not intend to introduce an earnings-related pensions scheme, so they should at least look more seriously at the question of earnings-related contributions to the National Health Service.

I say that because it seems to me that the public would accept it. People already think that the money is ear-marked. A recent survey showed that 60 per cent. of people thought that the total financing of the Health Service came out of their flat-rate contributions. This is an important psychological base from which one could proceed to increased contributions in order to make more resources available.

For my part, I put it to the Government that that is the way in which they could go for financing the National Health Service, but let them not think that they can increase contributions and reduce taxation as a quid pro quo, in effect keeping the total amount of finance going to the National Health Service the same. That would not do. I am advocating increased resources coming from contributions, the present taxation levels being kept as they are, though I realise that right hon. and hon. Gentlemen opposite have a psychological inability to recognise that our levels of taxation in this country are by any standards, in comparison with other countries, remarkably low. This is a fact, although they will rarely, if ever, accept it.

The Secretary of State has not allayed our anxieties. It is no use conducting this debate in terms of mild bromides from either side. There are fundamental economic issues at stake. The National Health Service must have a projected expenditure on which it can rely. The hospital building programme must not be the sacrificial cow in every review of public expenditure which each Government undertake. It is a great tribute to the last Government that at a time of economic stringency they preserved the hospital building programme. For many of us on this side, it left a bitter taste to have to swallow increased prescription charges, and at all times I respected those of my hon. Friends who felt that they could not support them. As they know, I defended the increased prescription charges because I did not want to cut the hospital building programme, and I saw no other way, but that was the measure of the sacrifice which we were prepared to make to preserve the fabric of the Service.

The Prime Minister has told us of his concept of one nation. Let him look to the National Health Service as a prime example of a service which must on no account be subject to divisive legislation or divisive reductions in the amount of money spent on it. The building-up of a two-tier Health Service would do irreparable harm to the development of his concept of one nation. We on this side of the House would most rigidly oppose it.

7.7 p.m.

Sir Brandon Rhys Williams (Kensington, South)

We have just had a serious and valuable contribution from the benches opposite. But before I go further, I would like to add my tribute to the maiden speech of my hon. Friend the Member for Cannock (Mr. Cormack), for a speech of quite outstanding quality which substantially enhanced the tone of the debate.

I am sorry that the right hon. Lady the Member for Blackburn (Mrs. Castle) is not here, because I wished to extend a welcome to her. Those of us who are seriously interested in the problems of the social services have felt that we were a rather small band of pilgrims. In the last Parliament, it would have been unusual on a social services day to have had half as many hon. and right hon. Members present as we have had in the Chamber this afternoon. I am delighted that the right hon. Lady has, apparently, been attached to our little band. I hope that she will stay with us and make such contribution as she is able to make, which will be a formidable one since she is a woman of great determination and grasp.

I served in the 28 skirmishes on the superannuation Bill in Standing Committee. Although Mr. David Ennals did not always agree with what I said, he did me the honour of taking the trouble to understand—which many hon. Members do not do—and I appreciated it. Although I congratulate the voters of Dover on the good sense which they showed at the General Election, I regret that David Ennals is not with us, for we shall feel the loss of his great knowledge and his pleasant personality.

This Motion deals primarily with health and hospitals. I am not the best person to speak about hospitals as I have not spent more than an hour or two hours, I suppose, in a hospital in the last 30 years. However, it raises the whole human problem and the whole cash problem of the future of the Welfare State, which will probably be one of the most absorbing subjects with which we shall be occupying our minds in this Parliament.

The right hon. Lady brought a certain amount of vinegar to mix with the milk of human kindness. I hope that, as she becomes more familiar with the way in which we try to study this subject of the human problem and the cash problem of the Welfare State, she will perhaps drop the rather partisan tone which she adopted this afternoon.

The Motion was put down, I think, rather with a view to inducing a fit of the shudders in the British electorate, than in the light of any particular item of knowledge of what the Government's intentions are. One seemed to hear, in the words of the old song, Round and round we go, Down and down we go, In a spin, Loving the spin we're in. I feel that the right hon. Lady, and some of the other speakers from the other side as well, have enjoyed the gruesome situation in which they find themselves, facing the prospect of the imminent collapse of the Health Service, and, indeed, of the entire Welfare State. They are hoping to be able to say to the electorate, "We told you so". I have a feeling it will prove very different. [Interruption.] Well, I think it was Sir Stafford Cripps who said that the cost of the Health Service should never exceed £800 million. It was only after a change of Government that that concept was swept away.

We have heard a lot about a two-tier service and here we have a real problem of philosophy. I think that where health is concerned the question of two standards is probably more acute than even in education. But we must be careful not to induce an equality of misery. I do not think many people are satisfied with the Health Service, and we want it to improve. Of course, we want it to improve for everybody, but it is not going to be easy to effect improvements which are felt by everybody simultaneously. One can make a mistake by eliminating the growth points, or the places where experiment leads to new advances, with a view to eliminating the upper tier, or the fortuitous cash advantage which people have who are in a position to pay.

Would there be in fact an improvement in the general standard of the Health Service if the private sector were swept away altogether? If hon. Gentlemen opposite really feel convinced of that why did they not, while they were in Government, eliminate the private sector? I think it is because, if one studies this subject, one cannot be convinced that it would be in the general interest to reduce everyone to a single standard and to fight against the natural human instinct that if one is in a position to pay for something—not necessarily even for oneself, but for one's family—one wants to pay for it. The Government may say "No", but in one way or another people will achieve it. I look at the problem of equality from the point of view of bringing the bottom up, rather than reducing the general standard. If we acquaint ourselves with the conditions in the very old-fashioned mental hospitals we cannot want not to bring everybody down but to eliminate the worst. That should be our first objective. We should not say, "Unless all can have it, nobody shall have it". That would not be in the general interest.

Mr. Will Griffiths

I should like the hon. Gentleman to consider this point. Under the present system many consultants are employed part-time in the National Health Service and part-time in private practice. Has he not heard, as many other hon. Members have heard, that there is sometimes a conflict between these two interests and that it leads to the disadvantage of the National Health Service?

Sir B. Rhys Williams

Indeed I have, and it would be quite wrong to neglect it, but one needs to consider the evidence of the emigration of doctors. If we try to discipline people against their natural instinct to better themselves, or to experiment, or to bring variety into their work, we cannot stop them from doing so. Many are doing so, and it would be a most dangerous development if we tried to insist to professional men that they should do only this and should not do that. It would certainly be dangerous in the fields of professional work with which I am personally more familiar than I am with medicine.

The general problem is one of finding more money from the public, and it is rather interesting to look at the philosophy here. One has to examine the policy of "from each according to his capacity and to each according to his needs".

Mr. James Dempsey (Coatbridge and Airdrie)

According to his ability.

Sir B. Rhys Williams

Well, the word means the same thing.

The Labour Party decided quite rightly that we should put National Insurance contributions entirely on an earnings-related basis. I hope that we shall soon hear the same from our own Front Bench. Should one then insist that everybody should have the same standard in exchange, regardless of the amount of his contributions? Or does one insist on having earnings-related benefits as well?

We have heard many arguments advanced from spokesmen of the Labour Party that when we have once introduced earnings-related contributions, we should no longer have flat-rate benefits. I myself have been more than once twitted because it seems to me that flat-rate benefits are very often appropriate.

To whom should the public pay their money? Is there any advantage in the public paying extra money to the hospitals and the general practitioners or the chemists? This raises the question of prescription charges, of course.

I am bound to say that I do not like prescription charges, and I think they have only one function, but it is a real function, and because they do seem to me to serve that purpose I think that prescription charges ought to remain; but they ought never to be large, and prescription charges ought never to be large because, even if they were, they would not bring in more than a small part of the cost of the Health Service. It is quite wrong, as some hon. Members opposite have suggested, to introduce prescription charges on the ground that the money is needed to save the Health Service. The money that they have brought in has really, in terms of the entire cost of the Health Service, been neither here nor there. The case for keeping prescription charges is that they act as a check on waste, and this is something which is in everybody's interests.

Mr. Will Griffiths

I want to examine this argument about check on waste. Is not the responsibility for prescribing placed solely upon the doctor? The patient may be the most dishonest person, the most outrageous supplicant, but, in the last analysis, the one who decides how public money should be spent in this respect is the doctor. Therefore, if charges are based on waste, we are misjudging the clinical judgment of the doctor. The doctor is the custodian of the public purse.

Sir B. Rhys Williams

There are many doctors who say that they need some sort of check on waste besides their own judgment. Where it is a question of quantities, there is something to be said for giving the public a sense of the actual value of the products being sold.

Mr. Arthur Lewis (West Ham, North)

The hon. Gentleman has given way two or three times already and I am grateful to him for giving way again, but can he explain this? A poor old gentleman or a poor old lady, who is chronically sick, has to keep going to the doctor and has to keep paying prescription charges whether he or she gets that money back from social security or not. How does that in any way avoid the need for that sick person either having to go to the doctor or having to get the doctor to prescribe? It makes no difference at all, surely?

Sir B. Rhys Williams

I sympathise with the hon. Member, because the administration of the prescription charges leaves a great deal to be desired. No one likes a situation in which so many people—four million now—are on supplementary benefit and have not enough to live on if they have to shell out even this small sum for prescription charges. The solution is to ensure that our old people are somewhat better off, so that they can pay their way with the rest of us.

Should the public pay their money simply to the tax collector and leave it to the State to provide the whole of the service? There are philosophical objections to that. First, or course, the biggest spenders are not always the wisest, and the State is not necessarily the best able to spend the publics money and to allocate it to best advantage. There is a moral objection to the provision of the Health Service in the form of what used to be known as "truck". I do not like the truck aspects of the Welfare State, because they take away the self-respect of the recipient. I do not like the truck element in education, and I would like some voucher system, whereby, as with family allowances, an individual child, or his parent or guardian, should be placed in a financial position to afford the education of the child. This would cost nothing more than the cost of public education at the moment, but it would be psychologically a great deal more satisfactory, because the parents could then pay for what the child obtained and not have to have it squeezed out for them in kind by the State.

The relationship between the patient and the Health Service is also unsatisfactory while health is squeezed out in the form of "truck". We got rid of this in the last century in the wage structure and we regard the system of payment in kind rather than cash by employers with opprobrium. Yet we allow it to continue in the twentieth century in our relationship with the State. I hope that it will become increasingly realised that the self-respect of the individual demands that he should be able to pay for the services he obtains, rather than have them issued to him like uniforms are issued in the Army.

As a third possibility, should the public pay their money to some insurance company—whether B.U.P.A. or some other company—so that the extra money contributions arising from the public's enthusiasm for health do not go to the tax collector or in prescription charges, but to an insurance company of their own choice, which would then be able to sustain them if they fell ill, either by affording the State services for them or by providing them with medical services of a completely different kind?

B.U.P.A. has been building its own hospitals lately, so private insurance is introducing a competitive element right the way through the Service. It is important that there should be an element of variety and choice available to the sick person. Unquestionably, the growth of the insurance companies is a way of bringing extra money into the Health Service, not simply because people wish to procure something better for themselves, but because it is always easier to pay something on top of an automatic benefit, without having to contract out completely, than to pay the whole thing for oneself.

It is easiest, perhaps, to see this in education. If parents were given, say, £150 towards the education of their child, they might be willing to find £50 or £100 on top, rather than have to find the whole amount themselves by taking their child completely outside the State system.

Mr. George Thomas

I do not want to do the hon. Gentleman an injustice, but I want to be quite sure that I have understood him correctly. Is he saying that private insurance companies should be encouraged to build their own hospitals?

Sir B. Rhys Williams

This raises the whole question of whether one wants two railway lines to Scotland or only one. I should say that it is desirable, within limits—but we are not likely to reach those limits for a long time—because we are so short of beds and facilities that any flow of money from the public into the building of hospitals must be welcomed and not criticised.

We have heard from thinkers about welfare services, particularly on this side the word "selectivity" a great deal in recent years. This word has a different meaning to everyone who uses it. Many people regard selectivity as a tax-cutting device—whereby one pays money only to those in need and not to those who cannot prove that they are in need. Therefore, it appears that one reduces the burden on the public purse, and it becomes possible to reduce taxation insofar as one has reduced the public outlay. But the fallacies of this argument are as apparent to hon. Members on this side as they seem to be to hon. Members opposite.

If one can save £100 by means of selectivity, and one then reduces taxation by £100, one is leaving everyone exactly where they were before. I am not sure who all these wonderful people are who are described as "those who can afford to pay"—and who must be made to do so. It seems to me that they are the very same people for whom our hearts are bleeding because they are over-taxed. To force them to pay for services which were formerly free to them is forcing them to pay their taxes simply by writing out a cheque to a different person—to the doctor or headmaster, instead of to the State.

There is no financial gain in introducing selectivity, unless, by changing the direction in which the cash flows, we can actually reduce the total cost. There are arguments that we can reduce the total cost of the service by changing the way in which the cash flows in and out of it. Let us examine them. First, there is the problem of supervision of capital expenditure, which is a major preoccupation in industry. Anyone who has spent time in industry, particularly, as I did, in the chemical industry, where the background is extremely capital intensive and is becoming more so, knows that the problem of the supervision of the people with the power to spend capital is very important. I do not imagine that things are very different in the public sector in this respect.

Only today, hon. Members will have been reading the pamphlet which has just been published by the Office of Health Economics. The Opposition might have framed their Motion rather differently had they read this pamphlet last week rather than today. The pamphlet is called "Building for Health" and it casts a good deal of doubt on the policy of the comprehensive district general hospital. I get a vision that this ideal of a vast comprehensive general hospital is rather like the Zeppelins which at one time were thought by many people to be the ne plus ultra in aeronautics, but which in retrospect can be seen to have been obsolete before the last was even built.

Perhaps these vast and glossy district general hospitals are using our scarce resources not necessarily to the best effect. I have met some architests who are working on these vast projects. Architects are always perfectionists, who want to make their name by what they are doing. They are also dedicated people, but they should come under commercial pressures, as they do when they are working with a builder who has a contract with a price tag on it. I am afraid that some architechts working on hospitals have lost all contact with the necessity to make the money go as far as possible. Schemes seem to be over-ambitious and perfectionist in a sense which the taxpayer cannot welcome. I think, too, that comprehensive general hospitals are now being seen to be increasingly remote from the communities which they serve.

The right hon. Lady mentioned geriatric and mental hospitals. She was suggesting that the new Government would be inclined to reduce expenditure in that area, where a cut-back would be particularly disastrous. I entirely agree that our geriatric and mental services are inadequate, appalling and a disgrace to our community in the twentieth century. That does not necessarily mean that we want our old and mentally ill people to be collected together, far away from their communities and from friends and relatives, in vast factories where they can be processed—and not necessarily in the cheapest possible way. There is more to be said for rehousing our old and mentally ill people in smaller, by all means new and comfortable premises, but as near as possible to the communities where they have links. I should like the new Government to have a careful look at the policy of concentration if it is indeed going as it seems to be going at present.

We also have the problem of the supervision of revenue expenditure. Here I will quote a few words from the pamphlet: No work has been done in this country to quantitfy precisely the overall costs and benefits of home care as against hospital care. If we have no idea of the relative costs of different methods of treatment, how can we make wise decisions? How can we in the House have intelligent debates when the data are not available, as I believe the data are not in this case. One objection to the spread of the insurance idea in the Health Service is that it is virtually impossible to arrive at an accurate and meaningful assessment of the costs of the services that people obtain. Individual services are not costed, and it is impossible to extract with any accuracy the difference between current expenditure and overheads. Are we making the best use of the land? Are we making the best use of the equipment and of the human resources in the Health Service if we have no idea of financial control or even the most elementary business techniques? We almost certainly are not.

Why is general practice in such a state of discontent? We all know that general practitioners are unhappy with their lot. When people are asking for more money, very often it is not really more money they want, although they may be right to ask for it; what they are asking for is more sympathy and more job satisfaction. Among general practitioners I have met there is an intense sense of insecurity and a consciousness of their declining status in the community. Many identify this as being a financial problem, and it may be partly a financial problem, but it is also a problem of the whole administration of the Health Service which seems to be squeezing the G.P.s downwards and outwards and reducing their professional status and authority.

I cannot help asking whether the direction of expenditure as it has been planned in the last five years does not make it harder rather than easier for general practitioners to participate in the Health Service and to give of their best. They are more and more excluded from following their patients into hospitals. This is not only a disadvantage for the patient but is also a disadvantage for the practitioner, because he has diminishing contact with serious medical experience. It is wrong that the general practitioner should be expected to deal with minor cuts, bruises and injections but as soon as he identifies a problem which is serious or requires even elementary equipment, he should have to pass his patient on to someone else to whom that patient will be more of a number than a name or person.

Why are general practitioners refusing to allow themselves to be integrated into local authority services? Local authorities are crying out for general practitioners to be integrated in the same way as social workers and child care officers; yet there appears to be a professional objection to doctors being brought under local authorities. I wonder how strong that objection is. It has been strongly voiced, but is it being strongly voiced on behalf of the entire profession or only on behalf of a relatively few people who have an ingrained horror of medically qualified people being brought under local authorities? I can understand doctors not wishing to be brought under very small local authorities, but that need not necessarily happen. It would be helpful to reconsider this apparent refusal by doctors to allow themselves to be guided by local authorities.

I should like to see general practitioners given more power to supervise the treatment of their patients once they have gone into these great comprehensive hospitals. It is always valuable for a second opinion to be obtainable, particularly in an age when we are increasingly recognising that there is a psychosomatic origin to so many of the problems of medicine. Someone who has known and sympathised with a man, who knows his family, his background, his occupation and his community can surely shed light on matters which will be obscure to a harassed specialist with no background knowledge, who sees a man for the first time only when his condition has become acute.

We have a serious cash problem in the future of the Health Service and the whole of the Welfare State. We must think extremely carefully who is paying what, to whom, and why. We have also a human problem, which is perhaps most important of all in the Health Service. I have the greatest possible confidence in the right hon. Gentleman who has been selected to be our Secretary of State. He combines a warm compassion with an exceptionally acute business sense, and I am certain that he is the right man to find the solutions.

7.36 p.m.

Mr. Kenneth Lomas (Huddersfield, West)

The hon. Member for Kensington, South (Sir B. Rhys-Williams) began by asking the Opposition to drop the partisan tone. The whole of his speech showed perfectly clearly the wide gulf between the Opposition and the Government on the National Health Service. The majority of hon. Gentlemen on the benches opposite do not understand the National Health Service because they do not use it. Hon. Gentlemen seemed to imply that to get a better service we should worship at the shrine of Mammon, but we want to create a Service that is free for all at the time of need, and which gives the best service irrespective of the individual's ability to pay. That is what the National Health Service is all about.

Aneurin Bevan said many years ago that the more and more goods that reached the consumer without going through the price mechanism the more civilised the world was becoming. This applies to the National Health Service. The more we can supply the services that are required for the sick, the infirm, the mentally handicapped, those suffering from spina bifida, spastics, the chronic sick and all those in need without those people having to dip into their pockets the more civilised we are becoming as a nation.

We now have a Tory Government. We have been promised Tory policy by the Chancellor of the Exchequer, and we know what Tory policy means. We have been told that there will be cuts in public spending, presumably to reduce taxation. To a man with two children earning an average wage, a reduction of 6d. in direct taxation will not make very much difference. He will be about 4s. a week better off. If that is to be done at the expense of imposing charges on the social services, never mind the value-added tax, and so on, and greatly reducing housing subsidies or imposing charges on the National Health Service, such a person will find himself infinitely worse off.

Mr. Arthur Lewis

Or increasing existing charges—which I agree my hon. Friend helped fight.

Mr. Lomas

I will come to those in a moment. I want to ask the party opposite a series of questions and to underline what my hon. Friend the Member for Halifax (Dr. Summerskill) said. We have the right to ask those questions, especially in view of the speech of the hon. Member for Melton (Miss Pike), who exposed the heart of Tory philosophy and spelt out what it means to be a Conservative and what is the Conservative attitude to the social services.

Surely by now right hon. and hon. Members opposite must have an idea of where they are going. Is it their intention to extend the system of pay beds in hospitals, so ensuring that money will buy privilege and that there can be queue-jumping? Is it their intention that a patient should pay his doctor when he sees him in his consulting room? Is it their intention that a doctor should receive a fee from his patient when he visits that person at home? Is it their intention that a patient going into hospital will be charged part of his keep? Is it their intention that consultants who at present give nine-elevenths of their services to the National Health Service and two-elevenths to private practice should be made to alter that balance? I should prefer to alter it so that all their work was done inside the National Health Service, but are they to be allowed to spend more time in the private sector, to the detriment of the vast majority of people in the public sector? These are all questions which right hon. and hon. Members on this side of the House, people in the country and certainly those who work in the National Health Service have a right to have answered.

I come next to prescription charges. I must refer to this matter because, like many of my hon. Friends, I am on record as voting against my own party when my right hon. Friends were the Government of the day.

Mr. Arthur Lewis

My hon. Friend has a very good record.

Mr. Lomas

If my right hon. Friend the Member for Blackburn (Mrs. Castle) and my right hon. Friend the Member for Cardiff, West (Mr. George Thomas) say in this debate that they hate prescription charges and will vote against them in future, we will welcome them back as two sinners who repenteth. I cannot help feeling that, if we had stuck to our principles, we would be in a better position to fight the present Government. Prescription charges merely penalise the sick. It is the philosophy of the Labour Party that our job is to protect the sick, the weak and the infirm, and that should be our overwhelming priority.

We hear talk from hon. Gentlemen opposite of the disquiet of doctors. That cannot be because of their low pay. We are told that it is a matter of job satisfaction. However, I remind hon. Gentlemen opposite that there are many ancillary workers in the National Health Service who earn only £10, £11 or £12 and who are not getting any job satisfaction. I am proud to belong to the National Union of Public Employees which represents them. By the very structure of the Health Service and the reluctance of hospital management committees and regional hospital boards, they are not even allowed to participate in any form of negotiation inside their hospitals, so they have neither money nor job satisfaction. At least the doctors have the money, and the junior doctors thoroughly deserve the money which we gave them at once during the election period. But it is hypocritical for hon. Gentlemen opposite who said in the election campaign "Give it all to them", now to say "Let us look at the position again."

Some of that money should have gone to the ancillary workers and nurses. We gave the nurses a substantial increase not long ago, but they deserve a lot more, because of the work that they do and the tremendous task that they perform for the community. But what is the Tory Party's policy towards our nurses? Is it that the right hon. and learned Member for Wirral (Mr. Selwyn Lloyd), who, not many years ago, stopped a 6d. in £ increase for them while easing the burden on surtax payers?

There are over 300,000 members of the National Union of Public Employees who work in the public sector. Like many others in the trade union movement up and down the country, they will not stand by and watch the National Health Service disintegrate before their eyes. We believe in a service which is available whenever it is needed. The hon. Member for Melton said that an hon. Member taken sick in this place receives immediate and better treatment. I was taken sick in this place just before Christmas on the evening of a three-line Whip. I was more or less confined in a Ministerial room with a couple of Army blankets round me. Shivering and perspiring freely, I was told to go through the Division Lobby, after which I could go home. I do not know whether that is what the hon. Lady means by better treatment. It is a guarantee of bronchial pneumonia, which is what I got. If that is better treatment, I can do without it. I want the same treatment as my constituents receive when they are sick.

The Tories talk about encouraging private insurance schemes. If people are allowed to contract out of the system, the position will be made infinitely worse. Waiting lists will grow, and people will suffer as a consequence. The service will certainly not improve. In fact, it will be worse for the vast majority. I hope that the Selsdon man knows not only where he is going but what his attitude is to these matters. He should spell it out tonight and give us some idea of Tory philosophy on the National Health Service. The House and the nation are entitled to know.

I wish to make one final point on the pension scheme. In the course of the election campaign, I found that what worried most people about the pensions set-up was the scheme introduced by the party opposite and regarded by many people as the greatest swindle ever perpetrated on the British nation. I refer to the graduated pensions scheme, where a person received 6d. on his pension at the end of the day after paying in £7 10s. Is it the intention of the party opposite to keep that scheme in being? Is it intended that people shall continue paying £7 10s. to get 6d. tacked on at the end, or will there be a proper graduated scheme providing a realistic pension when retirement comes?

Sir B. Rhys-Williams

The hon. Gentleman has referred to the scheme as a swindle. However, it should be remembered that the existing scheme, brought in in 1961, gives 34 per cent. of career earnings on retirement, whereas the proposed scheme incorporated in the national superannuation gives only 25 per cent. plus an index which links it to inflation. I ask the hon. Gentleman which is better: 34 per cent., or 25 per cent. and an inflation relationship? It depends, of course, on one's view of the prospect of ending inflation.

Mr. Lomas

The two cannot be equated. I thought that the scheme we had mind before the election was reasonably fair and just after all the compromises had been made. It meant that a person on the average wage at the end of the period came out with a pretty good pension. Under the scheme introduced by the Conservative Party this would not have applied. But it does not alter the fact that it was, and still is in my opinion, a swindle to pay £7 10s. in to get 6d. back. I feel that on the social services the Conservative Party conned the electorate in many ways. It made out that it could give people everything that they wanted and take nothing back. It made out that it could reduce taxes and at the same time improve the lot of the community. I do not believe that the Government can do those things unless they cut the essential services—the health service, housing, education, welfare services and the like.

I hope that we on this side of the House will fight to the bitter end to oppose anything that the Government might do to endanger the National Health Service and all for which it stands.

7.50 p.m.

Mr. Roger Moate (Faversham)

It is 25 years since Faversham last had a Conservative Member of this House. I am sure that hon. Members opposite, from whom we have heard a great deal about equality today, will recognise and perhaps applaud our desire to retain this seat for at least an equal number of years. Neither I nor, I am glad to say, the majority of constituents of Faversham would have wanted a different result on 19th June. But no one will disagree with me when I pay tribute to the constituency work and the sincerity of my predecessor, Mr. Terence Boston, who, by all accounts, was well liked on both sides of this House.

There can be few constituencies as diverse or as attractive as Faversham which contains, within its 200 square miles, a typical cross-section of our national life and an equally typical cross-section of our national problems, to many of which I shall be referring in future debates.

I particularly refer to the ancient borough of Faversham which shares with Sittingbourne, the largest of the towns in the constituency, a similar development of attractive, new housing estates, but with residents facing great burdens of high mortgage rates, soaring rail fares, long journeys to work and also to hospital.

The Isle of Sheppey represents one third of the constituency. It is surprising how often one has to remind people that nearly 30,000 people live on the island which has much to be preserved and a great potential to be developed.

We are faced with problems of high unemployment, of growth cramped by regional policies, of damage to the building and brick trade, and inadequate road and rail services. But there is also one acute short-term problem. Because of that I was particularly pleased, Mr. Deputy Speaker, to catch your eye. I refer to the grossly inadequate hospital services within the constituency, an inadequacy which has been further underlined by the closure of the important casualty ward on the Isle of Sheppey. Although this is a local problem, it is also symptomatic of something that is happening in the whole of Kent, and possibly throughout the country.

At this time of the year the Isle of Sheppey, with its important holiday trade, has a population swollen from 30,000 to nearly 60,000. It is linked to the mainland by a lifting bridge, which can sometimes be raised for an hour or more for repairs, and the crowded roads can mean that the 20-mile journey to the Medway accident centre can take a matter of hours. Hon. Members will understand the concern of local residents for the serious and tragic consequences that could flow from such a closure.

The fact is that there is an acute and serious shortage of casualty officers throughout the south of England. This shortage threatens many other important accident casualty centres in the area. It is a sad reflection on the times in which we live that in this most important aspect of our lives we are faced not with an improving or more convenient hospital service but with a cut back in local hospital services.

We have heard much this evening about the standard of living generally. Surely it is a major feature of our standard of living that we should provide adequate and convenient hospital services to the people of this country. There are many signs that this trend of cut backs will continue.

One major factor must be the terms of pay and the conditions of employment under which hospital doctors are working. We are informed that there is a continuing high rate of emigration of British doctors and that at the same time there is a reducing inflow of immigrant doctors coming here either to train or, indeed, to work. Neither of these trends is surprising. The fact is that they exist, and they indicate that a serious crisis could arise in our hospital service in the not-too-distant future unless action is taken in the fairly near future.

Listening to the debate today, in which there has been a great deal of ideological discussion, one would not have recognised that this type of crisis could arise fairly soon. It showed not an ideological battle between the two sides about where the money is to come from. It is a question of resources. We must provide more resources for our hospital services. Clearly it is a question of where the money will come from. I will return to this point briefly when I have dealt with one or two more important points on which I wish to touch.

I do not wish to go into the extensive arguments for or against a major programme for the district general hospital and the reducing rôle of the local hospital facilities. However, reference has been made to the report that came out this morning from the Office of Health Economics which cast serious doubt on placing too much reliance or emphasis on the district general hospital system. We must all recognise that those plans are so extensive and all-embracing that they virtually exclude the expansion of many of the other services. If we place too much emphasis on those services we could be running grave risks of running down other equally important local community facilities in the years ahead. I hope that it is not a question of ideology. I hope that the new Secretary of State will closely study the whole system and ensure that this major hospital programme is putting our limited resources to the best possible use.

There is plenty of evidence that only a small percentage of casualties and hospital cases need the intensive care and treatment with which we associate the major general district hospitals. Equally—this very much concerns Faversham—in a rural or partly rural, partly urban area the over-centralisation of resources means a starvation of the peripheral towns of services and an inevitable decline of the local services which they receive at present. To close a cottage hospital—this seems to be the trend at present—possibly means a serious loss of staff. Nurses who work locally will not travel considerable distances to the main centre. Certainly it means more inconvenience to patients and to visitors, and it means a loss of the community interest in that particular hospital.

Faversham has a hospital supported by the general practitioners. It is an excellent example of how a G.P. hospital can work very well for the local community. Incidentally it is backed by considerable sums of money raised by voluntary effort from the community. It seems a tragedy that the plans for our hospital services involve the community being deprived of this local interest. It is surely an unfortunate feature of the age that these plans for centralising resources should take away the community interest in something so vital as the health services.

Surely it is right—this comes back to the question of money—that the community should take a vital and a financial part in the provision of health services. If a small town wishes to see better facilities and cannot obtain those facilities through the National Health Service system, what is ideologically wrong with encouraging industry, perhaps encouraging the trade unions, through the taxation system, to provide those facilities at an earlier date than otherwise might be possible and perhaps encouraging individuals through the tax system to provide such facilities?

It is not just a question of their getting better treatment or helping the revenue of the hospital services at that time, but it could be that by looking closely at this whole question of community provision, or individual provision, we might be able to help with the whole capital programme as well. It seems to me a crazy philosophy which says that a person can provide himself with a television set, or candy floss, or a car, but when it comes to important things like health and education, private enterprise, private provision, is somehow improper or immoral.

I hope that we shall look closely at the whole question of private provision, because it could make a major contribution to the capital programme as well as to the current income position of the health services. I hope very much that dogma will not be allowed to intervene. We know that the hospital services will need far greater resources in the years to come. It is a question of where these come from, and if private provision can make a greater contribution, it is strange that hon. Gentlemen opposite should seek to oppose this.

I have been a little puzzled in hearing hon. Gentlemen opposite talk about prescription charges. Not having been here in previous Parliaments, I was under the impression that hon. Gentlemen opposite had introduced them, but to judge from the remarks of almost every speech from the Labour benches one would get the impression that a handsome majority would have voted against their introduction. One would like to think that, having gone through the traumatic experience of introducing charges, which made a minor contribution to the total revenue of the hospital services, they were perhaps moving towards bridging the gulf between us, and that ideology would no longer intervene.

It seems to me that on this whole question of the provision of hospital services we have to devote far greater resources; doctors have to be paid more, and there have to be better conditions of employment, otherwise in years to come we shall face a severe crisis. It is a crisis which we are facing locally in my constituency, and I hope very much that we shall be able to take steps to ensure that it is not a national crisis in years to come.

8.3 p.m.

Mr. Laurence Pavitt (Willesden, West)

I readily congratulate the hon. Member for Faversham (Mr. Moate) on his maiden speech. Its content was clear and, most important to me, he spoke clearly. I congratulate also his colleague the hon. Member for Cannock (Mr. Cormack) for speaking clearly, because very often some of his colleagues and mine mumble and we have considerable difficulty in hearing what they are saying. I know that the hon. Member for Faversham will not expect me to pick up some of the controversial points in my compliments to him, but I was appreciative of the gracious way in which he paid respect to Terence Boston, who was well liked and respected on both sides of the House.

The hon. Member may like to know that the hon. Member who represented the constituency before his immediate predecessor, Mr. Percy Wells, made a legend here. Hon. Members often forget things. A new Member often loses his briefcase, or his notes. But Percy Wells once left his wife behind. He arrived at Faversham to find that he had left his wife here and had gone home on his usual train. I hope that the hon. Gentleman will not have that experience.

A number of points have been raised during the debate, and I start with two raised by the right hon. Gentleman the Secretary of State, who I felt was giving us the Gospel of St. Joseph, with a large number of pages taken from the Gospel of St. Richard. I do not know whether I can call my right hon. Friend a saint now. He is more of a New Statesman than a Saint, but what the opening speech from the Government Front Bench has revealed is that whoever occupies that post and faces the facts of life finds that a large number of questions are common to both sides, and that when it comes to dealing with practical resources a good deal of the ideology has to go out of the window.

Hon. Members opposite have raised the question of the way in which private payments may add to the resources. The fantastic truth showing the irrelevance of this can be seen when one looks just at the question of pay beds. Out of 464,902 beds, there are only 4,030 pay beds. If anybody thinks that we are to get a lot of money from pay beds, this is nonsense in terms of arithmetic. The fact is that out of 4,030 pay beds only 1,928 were occupied last year, so that even if the figure is doubled one still does not touch the fringe of the problem.

I shall deal later with some of the other points which arise on the question of the resources of the service. I have had the privilege of participating in these debates for the last 10 years. I have noticed the change of batting sides on more than one occasion, but the regret of the result of the General Election for many of us is that after doing a number of unpopular things, after getting things straight, after doing the donkey work, it has been left to right hon. Gentlemen opposite to reap the harvest and sit in a very pleasant position.

In no respect is that more apparent than in the subject under discussion this afternoon, the National Health Service. In the last few years we have had the Salmon and P.B.I. Reports on Nurses; the Lycett Green Report on Administration; the Todd Report on Medical Education; the Sainsbury Report on Drugs; the new Voluntary Price Regulation Scheme which went into operation in October, 1969, the work on the whole question of mental subnormality; and the two Green Papers. Organisationally, there has been a fresh charter for G.P.s, which revised the original Spens Report; the whole increase of hospital buildings; the implementation of the district hospital schemes; the increase from 21 health centres in the first 20 years to nearly 300 in the next few years; the establishment of the Medicines Commission; pay increase for nurses given on a reasonable scale, and so on.

In spite of economic pressures, more cash and more facilities have been provided, and more thinking and more homework has been done during the last few years than since the establishment of the Health Service. There have been more improvements in all sectors. It is therefore heartbreaking to many of us on this side of the House who have been attached to this service for some time to find that just when all stations are set to go we are not going to be the people pulling the levers.

The opportunities for going ahead are in the hands of the Government and we are worried whether opportunities may be missed by delay, that their complacency, and Tory subconscious thought that disability and illness are the fault of the individual will ruin the opportunities present for them, because they have within their philosophy a strong feeling for individual responsibility, a worthy thing, but it often comes into conflict with community responsibility. In debate after debate in the House we have argued that health is a community responsibility and not a commodity for which one bargains in the market place according to the power of one's purse. We shall never have enough resources, manpower and facilities, and once we introduce any kind of pay system to command those things the inevitable consequence, however one likes to put it, is to set up a first- and second-class service.

The right hon. Gentleman asked for more time to consider them. I want to throw in a kind of Twenty Questions. If I do not get the answers tonight, I hope that I shall get them as time goes on. What is the Minister's policy with regard to group practice and health centres, and the way in which group practice will be organised? Does he approve of G.P. aides and ancillary staff for G.P.s, the kind of thing with which we have been experimenting over the last few years? What about certification for insurance, the recent doctors' strike? Does he think that this should become part and parcel of the Health Service, or part of the other side of his responsibility, the Ministry of Social Security? What does the right hon. Gentleman think of the relationship of G.P.s to hospitals?

On the hospitals themselves, does the right hon. Gentleman intend to revise the 1961 programme and get away from the basis of the district hospitals being the kingpins? What about the medical staff structure? Will he reorganise that? What is he going to do about contract work in hospitals, and the cost of contract radiology and other things, because we are not paying professions supplementary to medicine enough money to retain their services? Is his policy in respect of mental illness still to have more day hospitals and less institutional care? What about nursing care and nursing pay? Will he implement the Salmon Report? What kind of priority will he give on whether to spend on community care or £8,000 to £10,000 on a heart transplant? Will this be part of the responsibility that he has in mind?

And so one could go on from the top to the bottom of the scale—to the provision for the first time of deafness post-aural aids for 20,000 children. Will this be the kind of thing which happens or will the youngsters still have to have the corded Medresco, steel rimmed spectacles and things of that kind? Both at large and in detail, these are the kind of things we want to know, because when a new broom comes into the Department we want to know which way it sweeps and what it sweeps out.

Our major worry, however, is that it seems that a number of economists on the benches opposite think that an element of payment can provide more resources without harming the basic provision. In matters of health, this has proved to be sheer nonsense during the past 20 years.

Ten years ago, the statement was made in the Lancet which I have never been able to refute that arising from the introduction of prescription charges, The most significant lesson we have learned is that to introduce economic factors into the already complex relationship between doctors, patients and their illnesses leads to very unexpected results. It certainly does. One of the many non-senses from the recent charges is to imagine that prescription charges yield a figure of about £25 million. My present-day estimate is between £7½ million and £10 million in real terms and no more.

For example, in London alone the National Health Service employs in terms of whole-time equivalents, one executive grade, one higher clerical grade and six clerical grade officers in the London region on checking prescriptions at an estimated current annual cost of £10,200. Checks were completed on over 45,000 forms between 1st January, 1969, and 31st January, 1970. A total of 868 patients were found not to be entitled to exemption and £169 was recovered. At the moment, therefore, we are spending £10,200 in one area alone to recover £169 from people who are bilking their half-crown prescription charges. What economic nonsense!

What is even more appalling from the point of view of a compassionate Health Service is that people who are chronically sick are paying £¼ million on the season ticket system. This is a fleabite of 0.15 per cent. on the whole cost of the pharmaceutical services. In spite of the reintroduction of prescription charges, the drugs bill has increased. In 1968 it was £172.1 million and in 1969 £181.1 million, and this year it is £189.7 million. Therefore, any idea that the charges have acted as a deterrent has not been borne out by the facts.

One therefore looks at the implication of ways in which added resources could be made available. In previous debates, hon. Members opposite have often looked to the United States of America as a pattern. I should like to pay tribute to the fact that America is doing the opposite and is currently taking a leaf out of our book. Last week, Leonard Woodcock, a trades union leader of the automobile workers, managed to get a bill before Congress to have for the first time a national health insurance system in the United States. It would be a tragedy if, while America copies us, we put the clock back to the kind of system that prevails there.

I had the privilege recently of going to America to lecture. When I examined the whole question of the insurance principle and its impact—Blue Cross, Blue Shield and all the other schemes—I found that in America 13.5 per cent. of the population are not covered for hospitalisation, 20 per cent. are not covered for surgical treatment, 34.5 per cent. have no hospital medical treatment, 50 per cent. have no X-ray or laboratory facilities, 57.5 per cent. have no home medicine or G.P. service available, 61 per cent. have no coverage for medicines and 97.5 per cent. have no dental coverage.

When we examine how America is situated in the league tables of the World Health Organisation, we find that among other industrial countries America is fourteenth down the list in infantile mortality, eighteenth in the life expectancy of males, eleventh in the life expectancy of females and twelfth in the percentage of mothers who die in childbirth, and that the American male aged between 40 and 45 has less chance of living to 50 than have we who live in Europe, Canada, Australia or Japan.

An even worse situation prevails in the poorer section of the community, where 50 per cent. of mothers have no prenatal care, where there is a higher mortality and morbidity rate in mothers, where mortality in pregnancy is six times as great, mortality in infant diseases three and a half times as great and the poor American is four times as likely to die before the age of 35 than is the average American. This is at a time when the American Medical Association, which is even more reactionary, if that is possible, than the British Medical Asociation, is moving towards socialised medicine. I have a journal of medical economics in which a lecturer asks Who says Americans abhor socialised medicine? This is at a time when the Americans are worried because Medicare and Medicaid are leading to a 60 million dollar crsis. Do hon. Members opposite still think that we must take a leaf from the United States' book and make adaptations in our own Health Service on those lines?

We have had an interesting speech from my hon. Friend the Member for Woolwich, East (Mr. Mayhew) concerning subnormality. I urge the Secretary of State to pay attention to my hon. Friend's comments and I should like to add a few of my own. We have to realise that a lot has been done in this direction. At present, we spend £185.4 million on mental illness and subnormality. That is twice as much as we spend on things like coronaries and circulatory diseases and certainly twice as much as we spend on bronchitis and respiratory diseases. We are, therefore, doing something in this field.

Nevertheless, I should like to put on record two or three facts from the excellent book recently published by the association, written by Dr. Morris. First, there is an acute shortage of trained staff. One-third of all patients are in units where the senior nurse is unqualified in subnormality nursing. Senior nurses are often found cleaning their wards because of the sheer shortage of domestic staff. When we look at the way in which educational provision is made for the subnormal, we find that only 43 per cent. of school age patients attend school of any kind and that 67 per cent. of the teachers have no formal qualifications even in nursing. The school accommodation is totally inadequate.

I come to the quotation from Dr. Peter Townsend when he examined the material which was assembled in this extremely useful book, when he said There must be a complete reorganisation of services so that subnormal persons are no longer isolated in hospitals remote from the community but can be accepted into ordinary schooling. That is the trend which has been taking place in both mental ill health and mental subnormality. I hope that the Secretary of State's compassion will find practical expression in mental health and mental subnormality and that we shall be able to make definite progress.

One of the points which has been discussed in connection with resources has been the recent dispute over doctors' pay. I want to put on record what we have really been talking about, because in spite of the denial by the Leader of the House when I questioned him last Thursday, the impression was definitely given by the Prime Minister during the election that in the event of his party being returned to power, he would implement the Kindersley Committee's award for the profession.

I have produced the following figures for the convenience of those of my trade union colleagues who talk not in monthly or annual terms but in terms of wages per week. The weekly wage of a consultant with an A plus merit award is currently £233 16s. 5d. The Government propose to give him approximately another £30, or, to be precise, £29 1s. 11d. A consultant on his maximum with an A merit award receives £205 a week. He will get an extra £26 if the award is implemented. A consultant on his maximum with a B merit award at present receives £168 a week and the Government want to give him an increase of £21 12s. 5d.

I want, however, to pay tribute especially to the junior doctors. During the last two or three years I have worked closely with Dr. Piggott, Dr. Appleyard and Dr. Kathleen Bradley. They put up a tremendous fight for the junior hospital doctors and it was right that the previous Government should immediately give an award for them, because they have been over worked, under-valued and under-paid ever since the National Health Service began.

The ordinary registrar gets only a maximum of £55 and his minimum is £44. A senior house officer who has already done his eight years gets only £44 or £49 maximum. These are the people who deserve to get an award. The general practitioner gets an average of £133 a week, but it is only fair to say that this is his gross amount. He is really only on £100 a week, when his practice expenses are taken into account. Nevertheless, this award would give him another £33 each week.

The most fantastic thing to me is remembering when Mr. Kenneth Robinson was Minister of Health and how the Prime Minister of the day within a fortnight accepted the Kindersley Report but the B.M.A. rejected it, and 17,500 G.Ps. put in their resignations. It took us months to get a settlement of that, and the B.M.A. said, "Take negotiation away from the Kindersley Committee: let us negotiate direct." The doctors are never prepared to accept anything they do not like. When a previous Prime Minister, Mr. Harold Macmillan, appointed the Kindersley Committee, it was pretty well hand-picked by the B.M.A.: every nominee was checked by the B.M.A. before the appointment.

A big gap is caused by the fact that the Government has said nothing about the Health Service in the Queen's Speech. That is the gap of the restructuring on the basis of the two Green Papers that we have had. Since 1966, all the administrations responsible for the National Health Service have been in a state of flux, and this Government have left them in a state of vacuum, because they do not know whether we will get an integrated service, with hospitals, local executive councils and local health authorities running together under one administration, or another period of further discussion with organisations invited to comment.

The whole imaginative plan which some hon. Members have spoken about, about participation at local level and about whether local district committees will be implemented are in a vacuum, and it is unfair to administrators in the Health Service, who have to plan ahead as best they can, to leave them in this state of limbo. I hope that the Secretary of State will make a statement very soon about his intentions regarding the reorganisation and the restructuring of the Health Service.

Over the last 12 years, since the end of the 'fifties, the general consensus has been that these thre separate compartments no longer represent the most efficient way of organising the service. The Porritt Report of 1962 underlined the fact that this was generally accepted by most people actively engaged in the Health Service. I implore the Government not to let this drag on much longer. We were expecting a White Paper. I had a question down in May, because I rather suspected that the Ministry officials were jumping the gun and that most of it was in draft by the middle of May, without waiting for all the evidence which was due to come in by the end of the month.

Now, however, they will have had at least 150 submissions of opinion from hospital boards, local executive councils, and organisations like the National Union of Public Employees and the B.M.A. It is time that the Service was reorganised on these lines.

My hon. Friend the Member for Halifax (Dr. Summerskill) took up the point again—I hope that the hon. Gentleman will deal with it—of what will happen to the industrial and occupational Health Services. There were 301 million days lost last year through ill health, compared with fewer than 6 million lost through strikes—30 million through bronchitis and 31 million through respiratory diseases—yet all we can get from this Government is a lot of talk about disciplining the trade unions, with no one saying what they will do about getting people to work by preventing illness.

I am a member of the Medical Research Council and I went round the National Hospital this morning and saw some of the very modern technological things which are happening. The plea of the hon. Member for Melton (Miss Pike) for technical equipment is important, but she must know this does not lessen the cost of the National Health Service: it increases it. The more sophisticated the machines, the more one has to pay to use them. But I noticed a statement on the notice board in one of the consultant's rooms that we lost more national production every year through smoking than through all the strikes, official and unofficial, put together.

I commend that to the Under-Secretary. Will we still have a policy of an educational campaign to stop young people smoking? Will we have an industrial health policy? What arrangements will he make with the Department of Employment and Productivity. I hope he will continue the policy foreshadowed and take over the school health service and bring it within the ambit of the whole medical service. How comprehensive can one get? Also, industrial health?

I am certain that, unless these reorganisations which have been in the air so long are now implemented, not only will the Health Service suffer, but the patients will still be in the position—especially geriatric patients and the mentally ill and those who come under obstetrics—of being under three masters, without an efficient use of resources.

This is a new Government which has come in with a lot of old lumber in their ideas. I hope that, as a result of their grappling with the day-to-day problems, a lot of the old lumber of their ideological thinking will be shifted out.

8.26 p.m.

Mr. Nicholas Edwards (Pembroke)

I would ask the House for that courtesy to a new hon. Member which I understand it traditionally allows, even for the most inept performance, on the occasion of a maiden speech. I understand too that there is a convention that speeches on this occasion should not be controversial, but Members of Parliament for Pembroke find that an extraordinarily difficult convention to deal with. My predecessor established a tradition of rugged independence, and although I do not intend to follow him down all the strange paths that he chose to follow, I must say that rugged independence is something which I too value, particularly when it seems necessary for the prosperity and well being of those whom I have been elected to represent.

I can think of few counties where common interests, traditions and loyalties are stronger than they are in Pembroke. It is, I suppose, our remoteness from the rest of Britain, and the sense of isolation and identity that this produces, that causes us to fight so hard for those things we believe to be important.

In recent years few things have appeared more important than our fight for a better hospital, and it is because I believe that there are general lessons to be learned from that fight that I have chosen to speak in this debate, particularly as hon. Gentlemen opposite seem, as always, to be more concerned with the volume of expenditure than with the quality and content that it produces.

The Office of Health Economics Report, just released, is surely right to question whether we are spending our money wisely. It is not just an expanding programme of hospital building that we need. Certainty that we are building the right hospitals, an understanding of why, in some areas, people spend so much longer in hospital than in others—Wales is one of the places where they do this—and a greater concentration on providing more facilities to keep people out of hospital are vitally important.

There is widespread, though not universal, acceptance of the concept of the district general hospital. The Committee under the chairmanship of Desmond Bonham-Carter in 1965 expressed the view that it should serve an even larger group of population. Bonham-Carter, however, recognised two things; first, that if larger populations are to be served, patients and visitors must travel longer distances, causing practical and financial hardship.

The Commissioners drew attention to the need for the co-ordinated planning of hospital, ambulance and public transport systems, recommended that further financial aid should be given to those who could not otherwise afford to visit relatives and said that overnight accommodation should be provided for those who wished to be near the seriously ill or perhaps those who required treatment but did not need the use of a hospital bed. These recommendations are particularly important for remote areas like West Wales and I urge my right hon. Friend to give them the most urgent consideration.

The second and even more crucial qualification made by Bonham-Carter to the concept of the ideal general hospital is that in the more sparsely populated regions: … it will remain necessary to provide a district general hospital to serve less than 150,000 people and, in a very few places, even less than 100,000". This is the situation over the greater part of Wales, where a population of less than 1 million forms a great semicircle, from Wrexham to Carmarthen. In these sparser regions serious problems arise that require extremely careful consideration; and they have already seriously delayed the hospital building programme in some parts.

Bonham-Carter has recommended that there should be only two types of hospital, the district general and what the Commissioners rather inelegantly describe as "peripheral hospital units", by which they mean general practitioner hospitals under the direct supervision of the consultants at general district hospitals.

I believe that there is much more scope for the development of services in these smaller hospitals and I welcome the reference to this in our manifesto. However, some boards have got themselves into real trouble by creating something that falls almost exactly between the two types. Indeed, the Welsh Hospital Board has arrived at the rather surprising conclusion that the whole thing is no more than a matter of phraseology; that one can pacify the critics just by leaving the hospital as it is and changing its name.

This approach seems indefensible. I believe that anything described as a general hospital must be fully autonomous in the major specialities provided in that hospital. The larger hospitals will, of course, have additional specialities, and in that sense I suppose that they are supported by the smaller hospitals.

In other words, a hospital in a sparsely populated area may reasonably limit—indeed, must limit—the range of specialities that it offers. However, in no circumstances should it limit the service it offers in its own major specialities. In my view it is also quite wrong that any hospital designated a district general hospital should be without a fully-equipped accident unit.

Although medical opinion accepts that it is worth taking a patient a considerable distance to obtain the widest possible facilities, it cannot make sense to take an accident case past a general hospital to a hospital perhaps an hour or two away where there is one additional speciality but not all the specialities to be found in some of our largest hospitals. But that is exactly the scheme proposed for the new general hospital in Pembrokeshire.

I do not wish to bore the House with particular problems of West Wales, but I think that we should make sure that we are building the right kind of hospitals. It should be made clear that the granting of general hospital status is not just a matter of phraseology, but that such a hospital must achieve certain minimum standards that set it quite apart from a general practitioner hospital and enable it, among other things, to give immediate treatment to accident cases. The right hon. Gentleman the Member for Cardiff, West (Mr. George Thomas) knows better than most that in my constituency, with a population of well over 100,000 and with its developing industrial centre at Milford Haven, we will be satisfied with nothing less.

I should like to touch on one other important aspect of this problem. At present, the average time taken in this country between the decision to build a hospital and the start of the work is four years: in America it is about 18 months. In many cases here at least 10 years elapse between the moment of decision to build and the first occupation of the premises. The whole process is not only lengthy but adds greatly to the eventual cost. If we are talking of an expanding hospital programme we must improve on the present process of design and construction, particularly as in several cases the present system does not even justify itself by producing the best possible hospitals.

I believe that a case can be made out for taking the planning and execution work out of the hands of the hospital board and its committees and placing it in the hands of an executive officer, responsible to the board but responsible, too, for carrying out the work. I also believe that we have not given nearly enough attention to standardisation of ward and departmental design and layout, which should be based on the latest concepts kept continuously up to date by the Ministry's architects.

There would have to be a wide variety of such designs for different sites and conditions—perhaps nowhere is this more true than in Wales—but their use would enormously reduce the scope of argument—and, my goodness, some argument goes on—and that would ensure that schemes were based, not on local whims but on the latest ideas of the medical profession as a whole. They would also make for much greater use of industrialised building than has so far proved possible, and could result in a dramatic reduction in costs.

Hon. Members on both sides will be aware that we have gone some way in the use of standardised components, but this has so far only been an attack on the very fringes of the problem. If we are to make worth-while savings in hospital building costs we really must streamline the present cumbersome planning procedures, with their constant revision of plans and tenders.

We should also ask whether in many cases it is right to build in stages rather than complete the whole operation in one. While it is true that we might have to wait longer before starting on some hospitals, we would take away the need of contractors to remove their plant, tidy up the site and go elsewhere—a process both expensive and inconvenient.

Hon. Members opposite sometimes give the impression that the only solution to social problems is the expenditure of more and more money. I believe that we have to get better value for money, particularly in an area that is taking such a very high proportion of the total Health Service expenditure. The need to do that is one of the most urgent tasks facing the new Government.

I thank hon. Members for their courtesy.

8.40 p.m.

Dr. M. S. Miller (Glasgow, Kelvingrove)

I am very glad to congratulate the hon. Member for Pembroke (Mr. Nicholas Edwards) on his maiden speech. I listened carefully to his interesting contribution. He was obviously speaking from great knowledge of the subject.

It is rather fortuitous that this little booklet "Building for Health" has been published. I hope that there is nothing ominous, although there might have been, in its having been mentioned so often in this debate because there is a very considerable degree of misapprehension about what is meant by a hospital building programme.

We look forward to hearing more of the hon. Member's "rugged independence". Perhaps his rugged independence will lead him, as it did his predecessor, to cross from that side to this side of the House. As the hon. Member said, there is more to this question than spending money. Of course everyone wants more value for money, but that is exactly what we are talking about. We know that there is a necessity, in addition to the smaller hospitals which are being built, for large units and hospitals with large catchment areas to be built. If hon. Members believe that the answer to the problem of medicine is the little cottage hospital or the general practitioner hospital, their thinking is not in keeping with what is needed in the latter part of the twentieth century.

I had the honour of serving on the Sub-Committee on Hospital Building of the Estimates Committee. We went deeply into the question of system building and prefabrication for hospitals, but there are not enough hospitals being built for that to be done to any great extent. There is a certain amount of standardisation, but it is impossible completely to prefabricate sections of hospitals which, to a great extent, are specific and different in every case. Where it is possible for standardisation to take place, it takes place. I agree that this is a field which requires a considerable amount of continued investigation.

I was glad to hear the Secretary of State say that social benefits under the Service are abused by only a few people. One would imagine from speeches made during the General Election campaign that the whole of our social services were abused instead of only a small proportion of people taking unreasonable advantage of the facilities. It is not just 80 per cent. of the cost of the Health Service which is met by public funds, but about 97 per cent.

In a modern civilised society the hallmark is not its total wealth. This could often mean immense riches for a few people and abysmal poverty for the mass of people. The hallmark of a civilised society is development of its social services and its general attitude to care for its citizens. I do not intend in the short time available to try to cover the whole field. I will confine myself to certain aspects of the Health Service, in particular the general practitioner or family doctor service.

One development in recent times which has caused some trouble in the National Health Service—and hon. Members on both sides of the House have appreciated that there is some difficulty in the Service—is that the doctor is no longer looked upon as some kind of god. The spread of education has made the general public a little more discerning and perhaps a little more critical. People want to be consulted. They want to discuss with their doctor what is going on.

When I was in medical practice I was appalled at the number of new patients I examined who bore the scars of operations about the nature of which they had not the vaguest idea. The patient was expected to submit to an operation without question or discussion. This is a problem in the Service.

We are spending £100 million on hospital building and everybody except the consumer appears to be consulted. I agree with the hon. Member for Pembroke that there is far too much delay between a hospital's building being mooted and the occupancy of the hospital. Much of the delay is due to the medical profession, because at various stages of the building they confuse the issue and it is thrown back into the melting pot. Architects, surveyors, engineers, accountants, regional boards, hospital management committees, doctors and nurses are consulted, but not the potential patient.

The recent Green Papers for England and Wales and for Scotland stressed the necessity for the unification of the structure. The three branches are not sufficiently correlated and integrated. The hospital and specialist services, the family doctor services—I include the ophthalmic service, the dental service and the pharmaceutical service—and the local authority services, are distinct. Area or regional health boards are long overdue. Do the Government intend to proceed with the recommendation in this respect?

In 1950 we spent 4.42 per cent. of our national income on the Health Service. That percentage fell every year until about 1956 when it began to rise again. It did not reach 4.42 per cent. again until 1963. I am glad to say that it is now about 5.5 per cent. In 1950 11.7 per cent. of the total amount spent on the service was spent on general medical services. By 1968 that percentage had dropped to 7.9.

There are many problems in the family doctor area, but remuneration is not one of them. A net average annual salary of about £5,000 a year is not too bad. The action the doctors took last month was deplorable. It was right that the lower-paid hospital doctors should have been awarded the full 30 per cent. increase. However, there are many doctors who remember the days when they were young hospital doctors studying for extra degrees and when they would have been very pleased to have had any remuneration at all, instead of having to do it for nothing. In any case, it is about time we stopped awarding across-the-board increases, and this goes not only for the medical profession but for other professions and industry.

I maintain that the bone of contention is not remuneration. Many general practitioners are not satisfied that they are doing the work for which they are best fitted. I believe that where we are remiss here is in the provision of ancillary and para-medical services. The number of doctors per million of population is not the most relevant statistic here. For example, in 1851 we had in this country 800 doctors per million of population—one in 1,300. But by the next census this had fallen, because admission to the Medical Register was by examination and the number of doctors kept falling. In 1881 there were fewer than 600 per million of population in this country, but the last years of the 19th century saw a gradual rise, and the present figure is about 1,100 per million.

The question is: are we making the best use of this medical manpower? A recent publication entitled "General Practice Today"—again it is from the much-quoted Office of Health Economics—says: Now with the changing pattern of morbidity over the past 20 years, the previous system of 'family doctor' care has in any case ceased to be appropriate. Medical and social progress has fundamentally altered the pattern of sickness in the community. The work of the general practitioner in the 1930s was dominated by episodes of illness often requiring time-consuming and heroic, if relatively ineffective, treatment. Now illness is often contained quickly before it becomes serious and is usually treated by the administration of effective medicines, such as antibiotics, to the patient in his own home, or else by complicated technological procedures in hospital. General practice is now concerned more with chronic illness and social aspects of ill health. I believe that the shape of our family doctor service should have the general practitioner as the head of a little team. Doctors should work in groups of between four and six from health centres. They should have at their disposal to help them ancillary services, nursing services, health visitors, receptionists, typists and so on, and the doctor should be required to do work for which he is trained and not other jobs which do not concern him at all. The routine procedures should be left mainly in other hands.

Mention of training leads to the subject of the necessity for doctors to keep up to date. The number of doctors who take advantage of post-graduate schemes is not as high as it ought to be. Let me again quote from "General Practice Today": Post-graduate education for general practitioners has long been needed because of the rapid change in medical care and knowledge. A study in America showed that after ten or more years in general practice the practitioner's performance bore little relationship to undergraduate academic record". In this country in 1967 only 56 per cent. of general practitioners took advantage of post-graduate courses, but this is a great advance on the position in 1952 when only about 5 per cent. did.

There should be more chairs of general practice in our medical schools. The general practitioner is called upon to be a specialist in his own right. There is no field in which there is greater need for specialisation than geriatrics. This side of the matter has been mentioned already and I add just a word or two. There are now more than six million elderly people over 65 years of age in this country, and the proportion is rising. This field of medicine presents a tremendous challenge to the medical profession and to the development of our health services.

I close by asking the right hon. Gentlemen a few questions. Will he continue the building of health centres and the encouraging of general practitioners to work in and from them? Will he investigate the possibility of the general practitioner as the head of a team such as I have described? Will he encourage the teaching of general practice at medical schools and in hospitals? Will he let us have some proposals for consumer consultation? Finally, has he proposals for health education leading to disease prevention?

There are many challenges to be met. These challenges cannot be met by a static, rigid attitude towards the National Health Service. The Service must be dynamic and it must be flexible. In spite of what has been said by some hon. Gentlemen, it needs more money. Let the money be as cost-effective as we can possibly make it—let us have value for money—but let us have the money which is needed. I await with more than passing interest the Government's assurances and proposals that they will advance the Health Service, not retard it.

8.57 p.m.

Dame Irene Ward (Tynemouth)

May I have your guidance, Mr. Deputy Speaker? At what time am I required to sit down?

Mr. Deputy Speaker (Miss Harvie Anderson)

I have the impression that the Front Benches would be indulgent towards a further contribution, though I think that the time should be fairly short. I think that it would be reasonable to allow a few minutes.

Dame Irene Ward

Thank you, Mr. Deputy Speaker. I am delighted that my right hon. Friend the Member for Leeds, North-East (Sir K. Joseph) has become Secretary of State for Social Services. We all know what a deep interest he has taken in these services over a period of years. I look to him to be able to put into operation, while the Conservative Party is in office during this first Parliament following the Labour Government, a lot of the proposals which we have put forward from time to time to improve our social services.

The Opposition have been singularly unrealistic today. As I have counted them, about 100 requests for information from my right hon. Friend have been put by right hon. and hon. Members opposite. Everyone understands that a good deal of information has come into the hands of the Department over the years since the National Health Service was introduced, and, moreover, there are many new schemes, techniques and facilities which could be introduced and which I am sure my right hon. Friend will in due course consider. But it is idiotic, within the first month of this Government, to expect my right hon. Friend to give all his proposals without due consideration of all the reports, papers and knowledge which rest in the Ministry over which he now presides.

I should also like if I may to say one word to the right hon. Lady the Member for Blackburn (Mrs. Castle). I consider that she was a very up-to-date Minister. I shall not go any further than that, but I will say she was an up-to-date Minister, and I really was rather shattered when I heard her taking refuge in the old canard and starting off by saying that the Conservative Party had voted against the Second Reading of the National Health Service Bill.

Mr. Arthur Lewis

But that was true.

Dame Irene Ward

May I just put the record straight? That was in accordance with Parliamentary procedure. When the debate took place—in 1948, I think it was—on the National Health Service—[An HON. MEMBER: "1947."]—1947 then. It does not really matter which year it was when the original debate took place. When the National Health Service was introduced by the then Labour Government the Conservative Party, in Opposition, moved a considered Amendment.

Mr. George Thomas

No. On Second Reading?

Dame Irene Ward

On Second Reading we moved a considered Amendment. A great point of controversy at that time was whether there should be a salaried medical service within the National Health Service, and it was really on that point that the Amendment was moved, but we made it perfectly clear—perfectly clear—that we supported the introduction of the National Health Service, and to have an up-to-date—[Interruption.] If hon. Members opposite would only just be quiet. I have a voice just as loud as that of my right hon. Friend the Leader of the House—

Mr. Speaker rose—

Dame Irene Ward

—and I can shout when I want to.

Mr. Speaker

The hon. Lady will not shout me down, I hope.

Dame Irene Ward

I would never attempt to do that, Mr. Speaker, but you might shout the other side down as well as stop me.

It is quite extraordinary that, as I say, an up-to-date—I was going to say up-and-coming: I hope that the right hon. Lady is not going to come again—up-to-date Minister should have been so reduced to that criticism in moving this rather ridiculous Motion of censure proposed by her this afternoon.

I listened with great interest to what the hon. Lady the Member for Halifax (Dr. Summerskill) said when talking about all that had been done by the Labour Government for the National Health Service. I cannot exactly remember what she said about the speech of my hon. Friend the Member for Cannock (Mr. Cormack), but whatever was done, and a great deal was done, I am not denying, for the National Health Service by the Opposition during their period of office, that party certainly did not appear to pay much attention to the needs of Staffordshire and Cannock. I was delighted by the speech made by my hon. Friend the Member for Cannock and I hope that by the time we have to have another General Election he will be able to say that his party remedied all the deficiencies left in the National Health Service after a few years—far too long—of Labour Government.

I have only a moment left, for it has gone 9 o'clock, but I just wanted to say to my right hon. Friend that there are a great many very important issues on which decisions have got to be taken in the very near future, and I would briefly just mention one or two of them. Some very important reports have come from the Royal College of Nursing. There is one about the Abortion Act and one about the need for a special course of educational training for the nursing profession if it is to undertake the nursing of the subnormal, of the mentally afflicted. Those are two very important reports which have just come to hand. I would just say to my right hon. Friend that it is tremendously important that, instead of listening to a lot of claptrap which has come from the Opposition, it would be very helpful for the future of the National Health Service if he were to study reports from people who are engaged in the Health Service, engaged in nursing or in any of the various aspects of the Service, reports which require study before my right hon. Friend comes forward with his proposals.

In a very interesting maiden speech, my hon. Friend the Member for Pembroke (Mr. Nicholas Edwards) talked about the length of time it takes after a decision has been arrived at to build a hospital. We are waiting in North-East Northumberland for a decision on a hospital which was put in the pipeline in 1964. In my part of the world, which after all needs a great deal of help for many reasons, we want to know when we will get permission to go ahead.

Another important point is whether it is possible to make some use of prefabricated buildings. In my constituency, a very competent medical superintendent at one of the hospitals was anxious to have a department for pre-natal women to come in if they required overlooking before birth was due. We had plenty of land and also people who could build a prefabricated ward. It was all considered very suitable, but unfortunately the Ministry then said that it had to go to the Ministry architects. By that time, the cost of producing that very necessary ward was prohibitive.

It would be helpful to hospital management committees if, when there was a possibility of the committees doing something to help themselves, we did not always have imposed on us the high level of architectural design which the Department's architects seem to want to impose.

I could talk for at least three hours about what needs to be done, but I have already received guidance from Mr. Deputy Speaker. Now, I wish my right hon. Friend god-speed and, if he wants any help from the Treasury, he only has to come to me. I shall enjoy trying to persuade them to support what I am sure would be very good advice from him and his Department.

9.8 p.m.

Mr. George Thomas (Cardiff, West)

The hon. Lady the Member for Tyne-mouth (Dame Irene Ward)—I almost called her "the hon. and gallant Lady"—has been in the House a long time. I put up with the hon. Lady all right, but I do wish that, from time to time, she would read the Motion on the Order Paper. It would help us if she knew what she was talking about. The hon. Lady talked of a Motion of censure—

Dame Irene Ward

That is what it was meant to be.

Mr. Thomas

The hon. Lady is expert in interrupting, but she spoke of a Motion of censure. The Motion calls on the Government … to maintain the expanding programme of hospital building projected in the Labour Government's Public Expenditure White Paper … It also reaffirms a belief in a comprehensive National Health Servicing, giving equal treatment to all regardless of their ability to pay. The Government can censure themselves, if they vote against this Motion, because we call upon them to reaffirm the basic and essential principles upon which our National Health Service was founded.

The House has listened with deep interest to each of the maiden speakers who has addressed us today. The hon. Member for Bedwellty (Mr. Kinnock) is red-headed; we should have realised that he would make a contribution of like colour. He spoke with a fluency that is typical of the valleys from whence he hails. He abandoned the tradition of the non-controversial speech as other great people have done before him, but I followed the traditional lines.

The hon. Members for Harrow, East (Mr. Dykes), Cannock (Mr. Cormack), Faversham (Mr. Moate) and Pembroke (Mr. Nicholas Edwards) showed an impressive fluency. Even after 25 years' service I well recall my own maiden speech in this honourable House—I have no doubt that I am the only one who does recall it. I will not repeat it. I am impressed by the ease with which the new hon. Members rose and spoke as though they were addressing a parish meeting in North Wales. Each hon. Member who has addressed us for the first time tonight has brought considerable knowledge to his speech and I believe that the House will, with great advantage to itself, look forward to hearing these hon. Members again.

The debate has revealed the great divide between Government and Opposition on the National Health Service. It has been influenced by the Government having made no reference in the Gracious Speech to their plans for the Health Service and by the speech of the Secretary of State for Social Services. I congratulate him personally on his appointment, as I congratulate his colleague, the hon. Member for Barkston Ash (Mr. Alison), whom we shall hear for the first time tonight as a junior Minister. We hope to give him a warm welcome. My right hon. Friend the Member for Blackburn (Mrs. Castle) in opening the debate addressed to the Secretary of State some serious questions which he sought to avoid completely. These unanswered questions were bound to cause concern to the Opposition.

We are also disturbed because of our knowledge of Tory philosophy. A common theme of speakers from the Government side has been the emphasis upon the private sector playing a greater part in the National Health Service. The debate takes place in the shadow of the Chancellor of the Exchequer's grim warning last week that public expenditure reductions are an essential pre-requisite to the Government's plans for lower levels of taxation. He said that the conclusions he reaches will be laid before us in the autumn.

The significance of this debate, therefore, is that the Chancellor of the Exchequer will be fully informed on feeling in the House before he reaches his conclusions, and my right hon. and hon. Friends are right in seeking to convey to the Government their deep convictions and to obtain from right hon. and hon. Gentlemen opposite the principles upon which they intend to build.

The National Health Service touches the life of every family in the country. At one time or another, every family is brought in touch with the National Health Service, and it is natural that we on this side should take a special pride in it. It was our creation and, despite the intervention of the hon. Member for Tynemouth, right hon. and hon. Gentlemen opposite stirred up the doctors in an effort to stop the National Health Service from coming into being. The Conservative Party resisted its introduction and, ever since, has resented the basic principles on which it is founded. When previously in office, right hon. and hon. Gentlemen opposite starved the National Health Service of both funds and resources. They even reduced by 10 per cent. the intake of medical students. Thus they contributed substantially to the present shortage in the supply of doctors. By way of contrast, we have opened the door for the training by 1975 not of 2,700 doctors as at present but of 3,700.

In their policy pamphlet "The Family Health", issued in 1969 by the Conservative Political Centre, right hon. and hon. Gentlemen opposite stated: People would be required to insure themselves up to a certain minimum level in much the same way that car drivers are required to insure themselves against third party risks. We have had echoes of that philosophy in speeches from the benches opposite tonight. No doubt the most accident-prone in our community would pay the highest premiums. To those who work in industry, that is a fair warning of the philosophy which directs the Conservative Party.

The basic principle underlying the National Health Service is that we provide a comprehensive health service giving medical care regardless of the status or wealth of the patient. Fundamental to the concept of our National Health Service is the fact that no person is more important than his neighbour when it comes to care in times of sickness. To ensure that every citizen gets equality of care in sickness, we deliberately financed the Health Service out of taxation. This is based on the civilised principle that from each shall come according to his ability, to each according to his need.

To my mind, the basis of a National Health Service financed out of taxation is one of the most Christian acts ever passed by this House. I believe that all men are brothers, whether or not they are able to pay for private insurance. I happen to believe that there are no unimportant people in the country, but I also believe, with my right hon. and hon. Friends, that when people fall sick there should not be a privileged reception for those who happen to be better off than their neighbours.

The philosophy that we have been hearing from right hon. and hon. Gentlemen tonight gives privilege on the basis of a bank account. At present, through taxation, we ensure that the strong help the weak, that the rich help the poor, but not on the basis of patronage. On this basis the mother of a large but poor family, unable to pay for the private insurance that right hon. and hon. Gentlemen opposite are talking about, would be treated in the National Health Service the same as the mother of the Secretary of State, or my mother.

The philosophy of the Conservative Party has made clear to us that it puts great stress on people who are well off being able to buy extra in education and in health. It measures a man's importance by the size of his bank balance.

The emphasis which we have had tonight on private insurance purchasing extra for people who can afford it reveals, I believe, an arrogant philosophy of first-and second-class patients in hospital. The logic of the philosophy advanced by right hon. and hon. Gentlemen opposite is that we shall have a two-tier system within the National Health Service. Inevitably, the more the Government emphasise the importance of people paying private insurance for benefits in the Health Service, the more they will destroy the faith of people in its quality. By this philosophy they will make people feel that within the hospital service there are two forms of care and two forms of treatment.

There is a category of person in the country who just cannot afford the private insurance upon which such emphasis has been put. The chronic sick are the very people who could not afford this private insurance. Yet they are the people in need of the extras to make life more bearable in hospital.

My hon. Friend the Member for Willesden, West (Mr. Pavitt) reminded us of the lesson of the United States of America where the mental stress of the high cost of health insurance is causing public alarm to people carrying responsibility.

I want to draw a contrast between what we did when in office and what the Conservatives did. I ask the Under-Secretary, who is to reply, whether the Government have committed themselves to the estimates that we made for the continued expansion of the National Health Service. It is only a few months since the noble Lord, who is now the Minister of State for Defence, speaking from the Opposition Front Bench complained that the estimates that we submitted to the House for expenditure on the National Health Service in 1970–71 and 1971–72 were inadequate. He told us that not enough money was being spent or planned for the expansion of the National Health Service. Our estimates provided for an increase in expenditure of £300 million by 1972, and I want the Minister to tell us tonight whether the Government accept those estimates, or whether they are to be reduced.

I hope that the House will allow me to refer briefly to Wales, because the Welsh Office carries responsibility for the administration of the Health Service in Wales, and I use this merely as an illustration for the rest of the United Kingdom. The Prime Minister keeps a special arrogance for Wales—[HON. MEMBERS: "Oh."] I shall prove the arrogance in a moment. The Prime Minister has treated the Welsh people with the arrogance that we expect only from those who are feeling strong.

The Prime Minister has given to Wales two Ministers who were rejected by the Welsh people at the polls. The ride of Gilpin to York was nothing compared with the speed with which those two hon. Members went from Wales to safe English Tory seats, and apparently the Health Service in Wales is to be administered by edicts coming from Hendon and Hereford to the Welsh people. Those hon. Gentlemen washed their hands of Welsh constituencies. The last time they stood for seats in Wales they were defeated.

In 1963–64, the year that we took office, expenditure in Wales on health and welfare amounted to £55.3 million. In 1968–69 it had reached a total of £94.6 million, an increase of 70 per cent. In the one year that we were responsible for the Health Service in Wales my two colleagues Eirene White and Ted Rowlands, who unfortunately are no longer with us, but who will be back—

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

Rejected.

Mr. George Thomas

The Secretary of State says that they were rejected, but unlike the right hon. Gentleman they will fight again in Wales and come back. As I was saying, during the year when we were responsible for the health service in Wales my two colleagues and I paid personal visits to nearly 80 of our 200 hospitals. There are now two Ministers responsible for all the work. Education, apparently, is to be added to their responsibilities, and I say to the people of Wales that they cannot expect these two fellows—for nobody looks upon them as supermen—to take the personal interest in Welsh affairs that was possible under the previous Administration.

The Minister of State has one qualification at least. He is a big landlord in Wales. When I listened to the weird speech of the hon. Member for Kensington, South (Sir B. Rhys Williams), who is also a big landlord in Wales, I thought that may be if they are to fill the vacancy, he has a qualification for the job. During the 13 years that the Tory Party were responsible for health in Wales, they did not provide us with one health centre. We are glad to know that during the last five years 13 health centres were opened, that 15 more are nearing completion, that three more have been approved and that 11 are under consideration.

In the course of his speech earlier today, the Secretary of State, in one of his juggling exercises, started to talk about what the Conservative Party did about hospital building. There was a time when he was responsible for Welsh affairs. Welsh affairs was tacked on to his other responsibilities. That was the tory attitude to Wales.

In 1963–64 the hospital building programme in Wales, after 13 years on the part of the Tories, reached a total of £3.7 million. In 1968–69 it was more than doubled, and major schemes costing £26½ million are due for completion during the next four years. The right hon. Gentleman need not look at the clock. He had better look at his hon. Friend the Member for Tynemouth, because she took the time in the debate, and I intend to do the same. The hon. Lady was very discourteous to us.

I want to say a word about the long-stay hospitals. During the debate many hon. Members have referred to the tragedy of those who spend long periods in either geriatric or psychiatric hospitals or in hospitals for the mentally subnormal. My right hon. Friend the Member for Coventry, East (Mr. Crossman) consciously and deliberately decided, with the full agreement of his Cabinet colleagues, that we would take out of the health Estimate a specified amount of £3 million to be spent on our hospitals for the mentally subnormal. I copied that in Wales by getting the regional hospital board to allocate a proportional amount.

The country has neglected this side of the National Health Service. These are people who cannot fight for themselves. They are completely and utterly dependent upon civilised values being held in this House. I want the Minister when he replies to make it clear that the expenditure which we had planned for those hospitals for the mentally subnormal, for geriatrics and for psychiatric cases will be used as we had planned.

We had under way a new development plan for the care of the mentally handicapped. I ask the Minister to tell us what is his attitude to that plan, of which he will be aware.

Mr. F. A. Burden (Gillingham)

Give him time.

Mr. Thomas

I shall be fair. The hon. Lady the Member for Tynemouth went eight minutes over time.

Dame Irene Ward

Not at all. That is not true.

Mr. Thomas

I want to know whether the current investigation which we were holding into the relationship of buildings to patients will be continued by the Minister. But, above all, I want the Minister to tell us whether the Government will keep the country waiting for another four months to know their thinking on the National Health Service.

At Selsdon, they told us that they had the answers. At Selsdon, they said that they had a Queen's Speech ready. I regard the right hon. Gentleman as the Selsdon Man himself. Therefore, we must tell the Government that unless the Minister can give us satisfactory answers tonight—[An HON. MEMBER: "You will resign?"] Such a thought had not occurred to me. But we can promise the Minister hard opposition and bitter opposition, both here and in the country, if they intend to undermine the fundamental principles of the National Health Service.

9.36 p.m.

The Under-Secretary of State, Department of Health and Social Security (Mr. Michael Alison)

Those militant and belicose words from the right hon. Member for Cardiff, West (Mr. George Thomas) do not inspire us with any particular terror. Indeed, my right hon. Friend the Secretary of State commented, as we listened to the right hon. Gentleman's delightful Welsh speech, that he had all the charm of Liberace. I must say that I could visualise the two candles standing on the Dispatch Box as he speaks—

Mr. George Thomas

All I have to tell the Minister is that he will pay for that.

Mr. Alison

The National Health Service is free: the right hon. Gentleman might bear that in mind when he talks about paying for it.

But he also felt it necessary to make one or two comments about the English Members, as they now are, who used to sit for Welsh seats. That was a little unfair—because my right hon. and learned Friend the Secretary of State for Wales, who is the hon. Member for Hendon, South (Mr. Peter Thomas) now, was the Member for Conway. At least he presented himself to the electorate and was defeated, but the official candidate for Merthyr Tydvil did not get through to the election: he was rejected by his selection committee so they should not worry about English Members being chosen in this way. Anyway, in this election, we won back my right hon. Friend's earlier seat, Conway—[Interruption.] I will come on to mental health if the hon. Gentleman will contain himself.

As the right hon. Member for Cardiff, West did, I should like to pay some sincere compliments to the maiden speakers tonight. I dare not try to pronounce the name of the hon. Member for Bedwellty (Mr. Kinnock) in the way that the right hon. Gentleman did, but his was certainly a fluent and attacking speech. He managed to call the Government "humbugs" in his first speech. That shows that he is off to a flying, although not a very original, start. We also heard with great interest my right hon. Friend the Member for Harrow, East (Mr. Dykes) and we are glad that he combined considerable knowledge of the Health Service with a personal interest in it.

My hon. Friend the Member for Cannock (Mr. Cormack) said that he would be prodding us. If he prods us in the style and fluency with which he did tonight, we shall have no objection and it will certainly be much more constructive than the Motion before us. My hon. Friend the Member for Faversham (Mr. Moate) spoke with gseat knowledge about his seat, in which he succeeded Terence Boston whom we all liked here. I assure him that I have particularly noted the point he made about casualty and accident centres in his constituency. I have had reason to deal with this matter already and I shall address myself to the problem of accident centres in the Medway towns.

My hon. Friend the Member for Pembroke (Mr. Nicholas Edwards) likewise showed himself right up to date in dealing with some of the most complicated problems facing us in the disposition of hospital facilities, particularly in rural areas. As a county constituency representative, I am well aware of the difficulties that are faced by hospitals in remote areas, such as the need for people to travel long distances, and so on.

A word of appreciation about my predecessor, Dr. John Dunwoody. He established an enviable reputation, both for humanity and expertise, not only in the House but in the Department. His devotion to the work of the Department, his zeal in visiting a great number of hospitals, departmental centres and places of work throughout the country, which, perforce, cut the number of visits he was able to pay to his constituency, may have contributed to his defeat at the last election. We can record a salute to him, not only for the work he did but for his defeat, in that he went down for the best reasons. At the same time, I must accord a warm welcome to my hon. Friend the Member for Falmouth and Camborne (Mr. Mudd) who succeeded him.

It is fitting, before I plunge into the conflict which is inevitable in a debate on a Motion of this kind, for me to say a few non-partisan words about the Department to which I have had the great honour of being appointed and about the great medical and social work which it serves and sustains. Two things have particularly struck me as a newcomer to this Department. The first is the astonishing progress that has been made in the last 25 years in understanding, preventing and curing ill health in all its forms.

We sometimes forget when we put the National Health Service under the microscope of criticism—and often the criticism comes from both sides—that such diseases as smallpox, diphtheria, polio and typhoid fever have been almost completely eliminated in recent years. Heart and kidney transplants, the introduction of new drugs and new forms of surgery are making untimely death a rarity and we are extending life expectancy in a way that was unthinkable even a quarter of a century ago. Survival at birth has become more secure and definite, even for those who suffer from physical and mental handicaps.

A number of hon. Members have pointed out that the progress which we have made in the Service and the health which has been promoted has not lightened the burden on the Service. Paradoxically, the reverse is the truth. The revolution of rising expectations bites on the Health Service even more acutely than it does on any other sector.

I must comment on the huge number of those who work in and for the Service, and this is the second main point that has struck me. It is an enormous army—an army indeed, of more than three quarters of a million people, or more than the whole of our Armed Forces put together, the Navy, Army and Air Force.

This is an army not simply of doctors and nurses but of those whom we should especially remember, because they frequently have the least glamorous rôles to play and because they are not always directly involved with patients. They comprise many grades, from pharmacists, dieticians and radiographers to administrators and librarians. Librarians have a particularly important rôle to play, as have many of the other ancillary workers, including hon. Members who serve on regional hospital boards.

There is an enormous army of people supporting this work, and one could almost regard the Service as being one of our major industries. It certainly has its problems, but it also has its very great successes, and the impression that this debate should leave with the public is that although there is plenty in the Service that can be improved and put right, the dominating fact is that it is an enormously successful, promising and dedicated Service—

Mr. Richard Crossman (Coventry, East)

Hear, hear.

Mr. Alison

I am glad to have such support from such a quarter.

The Motion focuses our attention, unavoidably, on two subjects; the future and money. It is these two related factors on which I want to spend some time as we come to grips with the critical part of the Motion. But perhaps I might first be allowed to try to demonstrate the direction in which, as far as I can see, the new departures in health provision, the new emphasis in the provisions of the National Health Service are likely to lie in the next decade or the next quarter of a century. It is sticking one's neck out to try to isolate in advance the directions in which the new developments are most likely to lie, but if we are to appreciate where the money will go and how much of it will be needed, we should try to take a forward look at the main lines of development.

I believe that there are three main lines in which we can expect changes in the next decade, at any rate. The first is in science and technology. Past research and development, particularly into drugs and equipment, has brought very substantial changes to the Service and has involved the State in a very great deal of expenditure. One particular area of development in science and technology which I see bringing possibly great opportunities, but also making very considerable demands on the resources of the Service in future, is in automatic analysers. The National Health Service already uses a great number of automatic analysers, into which one feeds blood samples and gets automatic diagnoses, but I do not know whether the House appreciates that there are now very much bigger machines—

Mr. Speaker

Order. The hon. Gentleman cannot address the House against sustained conversation.

Mr. Alison

I am much obliged to you, Mr. Speaker, for your support.

There are some very remarkable automatic analysing machines in operation in the United States of America, costing perhaps £½ million each. They are capable of carrying out 24 separate diagnostic tests on blood samples fed into them, and in a very few minutes they suggest a whole range of possible ills or ailments in the individual concerned.

We can imagine the effect on the National Health Service if automatic analysis really comes in in this country in a very big way. As the hon. Member for Willesden, West (Mr. Pavitt) has pointed out, we already have some automatic analysers, but the scope for development is enormous, and I am terrified to think—[Interruption.]—perhaps I had better withdraw that phrase, and say that I am alarmed to think, to put it no higher, what the demands on resources may be if the public really get the bit between their teeth in regard to automatic analysers, with all the possible ills and ailments they may reveal. Here is one sector in which there may be some development in the future.

The second development has been touched on by a number of right hon. and hon. Members, and I take up in particular the hon. Member for Woolwich, East (Mr. Mayhew) whose speech exactly hit the point. The second important development that I can see in the next few years is the beginning of a substantial exodus from hospitals and a re-entry into community life. The exodus is likely to be most marked from hospitals for the mentally handicapped. I am glad that the right hon. Gentleman the Member for Cardiff, West focused attention on this aspect, because this seems to be the area not only in which the right hon. Gentleman the Member for Coventry, East (Mr. Crossman) showed real imagination but in which the public themselves, as he said, are singularly ignorant and, indeed, almost uninterested and casual.

I should like to give the House an illustration of the scope for exodus from some hospitals for the mentally handicapped and re-entry into community life by drawing attention to a recent medical survey carried out in a hospital for the mentally handicapped, in which there were 750 patients. At the end of the survey, it was discovered that no fewer than 40 per cent. were occupying beds for which there was really no need for the skills of the doctors and the nursing staff. Those 40 per cent. probably actually suffered from being in the hospital, contributing, as they did, towards overcrowding and lacking the stimulus which re-entry to community life and normal environment would have brought them.

Mr. Mayhew

I am most grateful for the hon. Gentleman's sympathetic reference on this point. One of the problems is that it is expensive to carry out. Can we be sure that the Government intend to make resources available to forward this idea?

Mr. Alison

I will go no further than to say that we very much appreciate the number of steps taken by the right hon. Member for Coventry, East within a fixed budget to reallocate and direct the emphasis in that direction.

This brings us to some of the expenditure problems involved. What is the alternative to keeping some of these people, particularly the 40 per cent. in this hospital, in hospital care? One of them is obviously a much wider provision in a local communal setting of training centres, day attendance centres, and residential accommodation. The House will be aware that the first training centres for the mentally handicapped, both children and adults, were started outside the Government sector.

Voluntary bodies took the lead in providing private residential accommodation. It is out of date and pointless to sneer, as some hon. Members opposite have done, at private voluntary provision when we see that local authorities are having to make considerable use on a contractural basis of residential accommodation provided by voluntary and other bodies for the community. There is great scope for this and we want to encourage it.

I wish to underline in this part of my speech the personal interest I have, which I hope to bring into the Department, in the needs of the mentally handicapped. This is a subject about which the House and the country should think a great deal more deeply. The mentally handicapped comprise virtually a legion of the lost and terribly deprived—tens of thousands of them. There are at least 60,000 mentally handicapped persons in hospitals. Many of them have complete difficulty in understanding anything and many have complete difficulty in making their needs known. Many, at the same time as being mentally handicapped, are also handicapped physically, blind, deaf or dumb.

One of the most shocking facts I have discovered is that of the 60,000 mentally handicapped languishing in hospital, between a third and a half are never visited and they have no links with any normal person in the outside world. Although the right hon. Member for Coventry, East has done the House and the country a service by getting through to this problem and highlighting it, it is a reproach to the country that we have only woken up to it so recently and very much as an accident. It is something which we have to take with the greatest seriousness. We must regard it as needing top priority.

It is worth pointing out that there is enormous scope here for volunteers. I underline that my right hon. Friend has asked me to look after this side of the problem particularly. The volunteers' contribution to the mentally handicapped is enormous. Over 2,000 volunteers visit and befriend about 5,000 patients. Nearly 1,000 volunteers help in organising various educational and recreational visits. Over 1,000 volunteers work in canteens. Six hundred volunteers help the nursing staff look after no fewer than 2,000 of the patients. There is an enormous amount of financial help given—Christmas presents, the financing of outings, the provision of television sets, and many other amenities.

I am glad to say that a very large proportion of the volunteers are drawn from the schools. Thirty-six per cent. of those who give voluntary help come either from the schools or through the Leagues of Hospital Friends. This means that if a mentally-handicapped patient returns to the community there will be an enormous amount of help to look after him.

The Motion is scarcely worth spending more than a few minutes on. As a Motion it is both silly and superficial. Indeed, if it is worth looking at for a moment, it is merely to see how silly it is. We are told that the Government's election commitments to reduce public expenditure are unrealisable commitments. If they are unrealisable, they will not be realised and there will not be any need for cuts in Government expenditure. So it is an extremely silly Motion to start with. [An HON. MEMBER: "That is not what it says."] It is exactly what it says— the unrealisable election commitments entered into by Her Majesty's Government. These election commitments were to cut public expenditure. If they are unrealisable, what are the Opposition worrying about?

The Motion is also extremely superficial. It focuses on one particular sum. The sum is set out in Table 216 of the White Paper mentioned in the Motion. The sum involved is exactly £2,002—I mean £2,002 million. [Laughter.] What are a few millions between the Opposition and the Government? Two thou-stand and two million pounds is the sum which is being focused on. This represents an increase of exactly £80 million between the present financial year—1970–71—and the year ahead. This is what the right hon. Lady and the right hon. Gentleman want us to be absolutely certain that we preserve. Eighty million pounds is the sacrosanct sum which the Government have got absolutely to guarantee with a forward commitment that they will not cut it, otherwise we have in some way desperately let down the British people and the National Health Service.

This includes incidentally, £36 million on hospital expenditure. This is the amount in that £80 million which is allocated to hospital expenditure. What a nerve the Opposition have to tell us that this £80 million, including £36 million, is absolutely sacrosanct. Have the Opposition forgotten the White Paper—[Interruption.] If hon. Members will keep quiet I will try to deal with the point.

Have the Opposition forgotten their White Paper of 16th January, 1968 in which, without any election pledges, without any election commitments, they presented to Parliament cuts in public expenditure of £60 million on health and welfare? Did they tell the public about that in advance—a £60 million cut in health and welfare expenditure?

In addition, the illogicality and inconsistency of the Opposition are even worse. In February, 1969, only nine months before they published the White Paper which they are harnessing to their cause tonight—Cmnd. 4234—they advanced estimates or projections for public

expenditure which were over £40 million higher than they set out in this, and that is more than the whole hospital building programme.

I advise my right hon. and hon. Friends without any hesitation to reject this ludicrous and petty Motion, which is so irrelevant to the true needs of the National Health Service.

Question put, That this House expresses its anxiety that the unrealisable election commitments entered into by Her Majesty's Government are likely to lead to damaging cuts in the social services, including the National Health Service; calls on Her Majesty's Government to maintain the expanding programme of hospital building projected in the Labour Government's Public Expenditure White Paper, Command Paper No. 4234, and reaffirms its belief in a comprehensive National Health Service giving equal treatment to all, regardless of their ability to pay:—

The House divided: Ayes 268, Noes 314.

Division No. 3.]	AYES	[10.0 p.m.
Abse, Leo	Cunningham, G. (Islington, S. W.)	Gunter, Rt. Hn. R. J.
Albu, Austen	Cunningham, Dr. J. A. (Whitehaven)	Hamilton, James (Bothwell)
Allaun, Frank (Salford, E.)	Dalyell, Tam	Hamilton, William (Fife, W.)
Alldritt, Walter	Darling, Rt. Hn. George	Hannan, William (G'gow, Maryhill)
Allen, Scholefield	Davidson, Arthur	Hardy, Peter
Archer, Peter (Rowley Regis)	Davies, Denzil (Llanelly)	Harper, Joseph
Armstrong, Ernest	Davies, G. Elfed (Rhondda, E.)	Harrison, Walter (Wakefield)
Ashley, Jack	Davies, Ifor (Gower)	Hart, Rt. Hn. Judith
Ashton, Joe	Davies, S. O. (Merthyr Tydvil)	Hattersley, Roy
Atkinson, Norman	Davis, Clinton (Hackney, Central)	Healey, Rt. Hn. Denis
Barnes, Michael	Deakins, Eric	Heffer, Eric S.
Barnett, Joel	Delargy, H. J.	Hilton, W. S.
Baxter, William	Dell, Rt. Hn. Edmund	Horam, John
Beaney, Alan	Dempsey, James	Houghton, Rt. Hn. Douglas
Benn, Rt. Hn. Anthony Wedgwood	Doig, Peter	Howell, Denis (Small Heath)
Bennett, James (Glasgow, Bridgeton)	Dormand, J. D.	Hughes, Rt. Hn. Cledwyn (Anglesey)
Bidwell, Sydney	Douglas, Dick (Stirlingshire, E.)	Hughes, Dr. Mark (Durham)
Bishop, E. S.	Douglas-Mann, Bruce	Hughes, Robert (Aberdeen, North)
Blenkinsop, Arthur	Driberg, Tom	Hughes, Roy (Newport)
Boardman, H. (Leigh)	Duffy, A. E. P.	Hunter, Adam
Booth, Albert	Dunn, James A.	Irvine, Rt. Hn. Sir Arthur (Edge Hill)
Boyden, James (Bishop Auckland)	Dunnett, Jack	Janner, Greville
Bradley, Tom	Eadie, Alex	Jay, Rt. Hn. Douglas
Broughton, Sir Alfred	Edelman, Maurice	Jeger, George (Goole)
Brown, Hugh D. (G'gow, Provan)	Edwards, Robert (Bilston)	Jeger, Mrs. Lena (H'b'n & St. P'cras, S.)
Brown, Bob (N'c'tle-upon-Tyne, W.)	Edwards, William (Merioneth)	Jenkins, Hugh (Putney)
Brown, Ronald (Shoreditch & F'bury)	Ellis, Tom	Jenkins, Rt. Hn. Roy (Stechford)
Buchan, Norman	English, Michael	John, Brynmor
Buchanan, Richard (G'gow, Sp'burn)	Evans, Fred	Johnson, Carol (Lewisham, S.)
Butler, Mrs. Joyce (Wood Green)	Faulds, Andrew	Johnson, James (K'ston-on-Hull, W.)
Callaghan, Rt. Hn. James	Fernyhough, E.	Johnson, Walter (Derby, South)
Campbell, Ian (Dunbartonshire, West)	Fisher, Mrs. Doris (B'ham, Ladywood)	Jones, Dan (Burnley)
Cant, R. B.	Fitch, Alan (Wigan)	Jones, Rt. Hn. Sir Elwyn (W. Ham, S.)
Carmichael, Neil	Fletcher, Ted (Darlington)	Jones, Gwynoro (Carmarthen)
Carter, Ray (Birmingh'm, Northfield)	Foley, Maurice	Jones, Barry (Flint, East)
Carter-Jones, Lewis (Eccles)	Ford, Ben	Jones, T. Alec (Rhondda, West)
Castle, Rt. Hn. Barbara	Fraser, John (Norwood)	Judd, Frank
Clark, David (Colne Valley)	Freeson, Reginald	Kaufman, Gerald
Cocks, Michael	Garrett, W. E.	Kelley, Richard
Cohen, Stanley	Gilbert, Dr. John	Kerr, Russell
Coleman, Donald	Ginsburg, David	Kinnock, Neil
Conlan, Bernard	Golding, John	Lambie, David
Corbet, Mrs. Freda	Gordon Walker, Rt. Hn. P. C.	Lamond, James
Cox, Thomas (Wandsworth, Central)	Gourlay, Harry	Latham, Arthur
Crawshaw, Richard	Grant, George (Morpeth)	Lawson, George
Cronin, John	Grant, John D. (Islington, East)	Leadbitter, Ted
Crosland, Rt. Hn. Anthony	Griffiths, Eddie (Brightside)	Lee, Rt. Hn. Frederick
Crossman, Rt. Hn. Richard	Griffiths, Will (Exchange)	Leonard, Dick
Lestor, Miss Joan	O'Halloran, Michael	Small, William
Lever, Rt. Hn. Harold	O'Malley, Brian	Smith, John (Lanarkshire, North)
Lewis, Arthur (W. Ham N.)	Oram, Bert	Spearing, Nigel
Lewis, Ron (Carlisle)	Orbach, Maurice	Spriggs, Leslie
Lipton, Marcus	Orme, Stanley	Stallard, A. W.
Lomas, Kenneth	Oswald, Thomas	Stewart, Rt. Hn. Michael (Fulham)
Loughlin, Charles	Owen, Dr. David (Plymouth, Sutton)	Stoddart, David (Swindon)
Lyon, Alexander W. (York)	Padley, Walter	Stonehouse, Rt. Hn. John
Lyons, Edward (Bradford, East)	Paget, R. T.	Strang, Gavin
Mabon, Dr. J. Dickson	Palmer, Arthur	Strauss, Rt. Hn. G. R.
McCann, John	Pannell, Rt. Hn. Charles	Summerskill, Hn. Dr. Shirley
McCartney, Hugh	Parker, John (Dagenham)	Swain, Thomas
MacColl, James	Parry, Robert (Liverpool, Exchange)	Taverne, Dick
McElhone, Frank	Pavitt, Laurence	Thomas, Rt. Hn. George (Cardiff, W.)
McGuire, Michael	Peart, Rt. Hn. Fred	Thomas, Jeffrey (Abertillery)
Mackenzie, Gregor	Pendry, Tom	Thomson, Rt. Hn. G. (Dundee, E.)
Mackie, John	Pentland, Norman	Tinn, James
Mackintosh, John P.	Prentice, Rt. Hn. Reg.	Tomney, Frank
Maclennan, Robert	Prescott, John	Torney, Thomas
McNamara, J. Kevin	Price, J. T. (Westhoughton)	Tuck, Raphael
Mahon, Simon (Bootle)	Price, William (Rugby)	Urwin, T. W.
Mallalieu, E. L. (Brigg)	Probert, Arthur	Wainwright, Edwin
Mallalieu, J. P. W. (Huddersfield, E.)	Rankin, John	Walden, Brian (B'm'ham, All Saints)
Marks, Kenneth	Reed, D. (Sedgefield)	Walker, Harold (Doncaster)
Marquand, David	Rees, Merlyn (Leeds, S.)	Wallace, George
Marsh, Rt. Hn. Richard	Rhodes, Geoffrey	Watkins, David
Mason, Rt. Hn. Roy	Richard, Ivor	Weitzman, David
Meacher, Michael	Roberts, Albert (Normanton)	Wellbeloved, James
Mellish, Rt. Hn. Robert	Roberts, Rt. Hn. Goronwy (Caernarvon)	Wells, William (Walsall, N.)
Mendelson, John	Robertson, John (Paisley)	White, James (Glasgow, Pollok)
Mikardo, Ian	Roderick, Caerwyn E. (Br'c'n & R'dnor)	Whitehead, Phillip
Millan, Bruce	Rodgers, William (Stockton-on-Tees)	Whitlock, William
Miller, Dr. M. S.	Roper, John	Willey, Rt. Hn. Frederick
Milne, Edward (Blyth)	Rose, Paul B.	Williams, Alan (Swansea, W.)
Molloy, William	Ross, Rt. Hn. William (Kilmarnock)	Williams, Mrs. Shirley (Hitchin)
Morgan, Elystan (Cardiganshire)	Sheldon, Robert (Ashton-under-Lyne)	Wilson, Alexander (Hamilton)
Morris, Alfred (Wythenshawe)	Shore, Rt. Hn. Peter (Stepney)	Wilson, William (Coventry, S.)
Morris, Charles R. (Openshaw)	Short, Rt. Hn. Edward (N'c'tle-u-Tyne)	Woof, Robert
Morris, Rt. Hn. John (Aberavon)	Short, Mrs. Renée (W'hampton, N. E.)
Moyle, Roland	Silkin, Rt. Hn. John (Deptford)	TELLERS FOR THE AYES:
Mulley, Rt. Hn. Frederick	Silkin, Hn. S. C. (Dulwich)	Mr. J. D. Concannon and
Murray, Hn. Ronald King	Sillars, James	Mr. William Hamling.
Ogden, Eric	Skinner, Dennis
NOES
Adley, Robert	Campbell, Rt. Hn. G. (Moray & Nairn)	Edwards, Nicholas (Pembroke)
Alison, Michael (Barkston Ash)	Carlisle, Mark	Elliot, Capt. Walter (Carshalton)
Allason, James (Hemel Hempstead)	Carr, Rt. Hn. Robert	Emery, Peter
Amery, Rt. Hn. Julian	Cary, Sir Robert	Eyre, Reginald
Archer, Jeffrey (Louth)	Channon, Paul	Farr, John
Astor, John	Chapman, Sydney	Fell, Anthony
Atkins, Humphrey	Chataway, Rt. Hn. Christopher	Fenner, Mrs. Peggy
Awdry, Daniel	Chichester-Clark, R.	Fidler, Michael
Baker, W. H. K.	Churchill, W. S.	Finsberg, Geoffrey (Hampstead)
Balniel, Lord	Clark, William (Surrey, East)	Fisher, Nigel (Surbiton)
Barber, Rt. Hn. Anthony	Clarke, Kenneth (Rushcliffe)	Fletcher-Cooke, Charles
Batsford, Brian	Clegg, Walter	Fookes, Miss Janet
Beamish, Col. Sir Tufton	Cockeram, Eric	Fortescue, Tim
Bell, Ronald	Cooke, Robert	Foster, Sir John
Bennett, Sir Frederic (Torquay)	Coombs, Derek	Fowler, Norman
Bennett, Dr. Reginald (Gosport)	Cooper, A. E.	Fox, Marcus
Benyon, W.	Cordle, John	Fraser, Rt. Hn. Hugh (St'fford & Stone)
Berry, Hon. Anthony	Corfield, F. V.	Fry, Peter
Biffen, John	Cormack, Patrick	Galbraith, Hn. T. G.
Biggs-Davison, John	Costain, A P.	Gardner, Edward
Blaker, Peter	Critchley, Julian	Gibson-Watt, David
Boardman, Tom (Leicester, S. W.)	Crouch, David	Gilmour, Ian (Norfolk, C.)
Body, Richard	Crowder, F. P.	Gilmour, Sir John (Fife, E.)
Boscawen, R. T.	Curran, Charles	Glyn, Dr. Alan
Bowden, Andrew	Dalkeith, Earl of	Godber, Rt. Hn. J. B.
Boyd-Carpenter, Rt. Hn. John	Dance, James
Braine, Bernard	Davies, John (Knutsford)	Goodhart, Philip
Bray, Ronald	d'Avigdor-Goldsmid, Sir Henry	Goodhew, Victor
Brewis, John	d'Avigdor-Goldsmid, Maj.-Gen. Jack	Gorst, John
Brinton, Sir Tatton	Dean, Paul	Gower, Raymond
Brocklebank-Fowler, Christopher	Deedes, Rt. Hn. W. F.	Grant, Anthony (Harrow, C.)
Brown, Sir Edward (Bath)	Digby, Simon Wingfield	Gray, Hamish
Bruce-Gardyne, J.	Dixon, Piers	Green, Alan
Bryan, Paul	Dodds-Parker, Douglas	Grieve, Percy
Buchanan-Smith, Alick (Angus, N & M)	Douglas-Home, Rt. Hn. Sir Alec	Grimond, Rt. Hn. J.
Buck, Antony	Drayson, G. B.	Grylls, Michael
Bullus, Sir Eric	du Cann, Rt. Hn. Edward	Gummer, Selwyn
Burden, F. A.	Dykes, Hugh	Gurden, Harold
Butler, Adam (Bosworth)	Eden, Sir John	Hall, Miss Joan (Keighley)

Hall, John (Wycombe)	McCrindle, R. A.	Royle, Anthony
Hall-Davis, A. G. F.	McLaren, Martin	Russell, Sir Ronald
Hamilton, Michael (Salisbury)	Maclean, Sir Fitzroy	St. John-Stevas, Norman
Hannam, John (Exeter)	Macmillan, Maurice (Farnham)	Sandys, Rt. Hn. D.
Harrison, Brian (Maldon)	McNair-Wilson, Michael	Scott, Nicholas
Harrison, Col. Sir Harwood (Eye)	McNair-Wilson, Patrick (New Forest)	Scott-Hopkins, James
Haselhurst, Alan	Madel, David	Sharples, Richard
Hastings, Stephen	Marples, Rt. Hn. Ernest	Shaw, Michael (Sc'b'gh & Whitby)
Havers, Michael	Marten, Neil	Shelton, William (Clapham)
Hawkins, Paul	Mather, Carol	Simeons, Charles
Hay, John	Maude, Angus	Sinclair, Sir George
Hayhoe, Barney	Maudling, Rt. Hn. Reginald	Skeet, T. H. H.
Heath, Rt. Hn. Edward	Mawby, Ray	Smith, Dudley (W'wick & L'mington)
Heseltine, Michael	Maxwell-Hyslop, R. J.	Soref, Harold
Hicks, Robert	Meyer, Sir Anthony	Speed, Keith
Higgins, Terence L.	Mills, Peter (Torrington)	Spence, John
Hiley, Joseph	Miscampbell, Norman	Sproat, Iain
Hill, J. E. B. (Norfolk, S.)	Mitchell, David (Basingstoke)	Stainton, Keith
Hill, James (Southampton, Test)	Mitchell, Lt.-Col. C. (Aberdeenshire, W)	Stanbrook, Ivor
Holland, Philip	Moate, Roger	Stewart-Smith, D. G. (Belper)
Holt, Miss Mary	Money, Ernle D.	Stodart, Anthony (Edinburgh, W.)
Hooson, Emlyn	Monks, Mrs. Connie	Stoddart-Scott, Col. Sir M.
Hordern, Peter	Monro, Hector	Stokes, John
Hornby, Richard	Montgomery, Fergus	Stuttaford, Dr. Tom
Hornsby-Smith, Rt. Hn. Dame Patricia	Morgan, Geraint (Denbigh)	Sutcliffe, John
Howe, Hn. Sir Geoffrey (Reigate)	Morgan-Giles, Rear-Adm.	Tapsell, Peter
Howell, David (Guildford)	Morrison, Charles (Devizes)	Taylor, Sir Charles (Eastbourne)
Howell, Ralph (Norfolk, North)	Mudd, David	Taylor, Frank (Moss Side)
Hunt, John	Murton, Oscar	Taylor, Robert (Croydon, N. W.)
Hutchison, Michael Clark	Nabarro, Sir Gerald	Tebbit, Norman
Iremonger, T. L.	Neave, Airey	Temple, John M.
Irvine, Bryant Godman (Rye)	Nicholls, Sir Harmar	Thatcher, Rt. Hn. Mrs. Margaret
James, David	Noble, Rt. Hn. Michael	Thomas, John Stradling (Monmouth)
Jenkin, Patrick (Woodford)	Normanton, Tom	Thomas, Rt. Hn. Peter (Hendon, S.)
Jennings, J. C. (Burton)	Onslow, Cranley	Thompson, Sir Richard (Croydon, S.)
Jessel, Toby	Oppenheim, Mrs. Sally	Tilney, John
Johnson Smith, G. (E. Grinstead)	Osborn, John	Trafford, Dr. Anthony
Johnston, Russell (Inverness)	Owen, Idris (Stockport, North)	Trew, Peter
Jones, Arthur (Northants, South)	Page, Graham (Crosby)	Tugendhat, Christopher
Jopling, Michael	Page, John (Harrow, W.)	Turton, Rt. Hn. R. H.
Joseph, Rt. Hn. Sir Keith	Peel, John	van Straubenzee, W. R.
Kaberry, Sir Donald	Percival, Ian	Vaughan, Dr. Gerard
Kellett, Mrs. Elaine	Peyton, Rt. Hn. John	Vickers, Dame Joan
Kerby, Capt. Henry	Pike, Miss Mervyn	Waddington, David
Kershaw, Anthony	Pink, R. Bonner	Walder, David (Clitheroe)
Kilfedder, James	Powell, Rt. Hn. J. Enoch	Walker, Rt. Hn. Peter (Worcester)
Kimball, Marcus	Price, David (Eastleigh)	Walker-Smith, Rt. Hn. Sir Derek
	Prior, Rt. Hn. J. M. L.	Wall, Patrick
King, Evelyn (Dorset, South)	Proudfoot, Wilfred	Walters, Dennis
King, Tom (Bridgwater)	Pym, Rt. Hn. Francis	Ward, Dame Irene
Kinsey, J. R.	Quennell, Miss J. M.	Warren, Kenneth
Kirk, Peter	Raison, Timothy	Weatherill, Bernard
Kitson, Timothy	Ramsden, Rt. Hn. James	Wells, John (Maidstone)
Knight, Mrs. Jill	Rawlinson, Rt. Hn. Sir Peter	White, Roger (Gravesend)
Knox, David	Redmond, Robert	Whitelaw, Rt. Hn. William
Lambton, Antony	Reed, Laurance (Bolton, East)	Wiggin, Jerry
Lane, David	Rees, Hn. Peter (Dover)	Wilkinson, John
Langford-Holt, Sir John	Rees-Davies, W. R.	Wolrige-Gordon, Patrick
Legge-Bourke, Sir Harry	Renton, Rt. Hn. Sir David	Woodhouse, Hn. Christopher
Le Marchant, Spencer	Rhys Williams, Sir Brandon	Woodnutt, Mark
Lewis, Kenneth (Rutland)	Ridley, Hn. Nicholas	Worsley, Marcus
Lloyd, Rt. Hn. Geoffrey (Sut'n C'dfield)	Ridsdale, Julian	Wylie, Rt. Hn. N. R.
Lloyd, Ian (P'tsm'th, Langstone)	Rippon, Rt. Hn. Geoffrey	Younger, Hon. George
Lloyd, Rt. Hn. Selwyn (Wirral)	Roberts, Michael (Cardiff, North)
Longden, Gilbert	Roberts, Wyn (Conway)	TELLERS FOR THE NOES:
Loveridge, John	Rodgers, Sir John (Sevenoaks)	Mr. R. W. Elliott and
McAdden, Sir Stephen	Rossi, Hugh (Hornsey)	Mr. Jasper More.
MacArthur, Ian	Rost, Peter

BUSINESS OF THE HOUSE

Ordered,

That thsis day the proceedings on the Education (Handicapped Children) Bill may be entered upon and proceeded with at this day's Sitting at any hour, though opposed.—[Mr. Fortescue.]