HC Deb 19 March 1970 vol 798 cc673-82
Mr. Speaker

Order. I remind the House that if an hon. Member wishes to join in a debate on any topic, he must let the Chair know.

6.30 p.m.

Mr. John Fraser (Norwood)

It has been said that there was an old woman who lived in a shoe and had so many children that neither she nor anyone else who wanted to help her knew what to do. That is no longer the case. Certainly it cannot be said of those who wish to assist families who are in need of family planning. However, it remains true that many women today risk unwanted pregnancies as a result of ignorance.

It would be sterile to discuss the effect of the use of family planning devices. I intend to confine myself to those parts of the Supplementary Estimates which deal with increased expenditure on family planning services and the extent to which money will be used as a result of the increased interest which the Government have shown in this policy by providing funds for private individuals, voluntary bodies, local authorities, hospitals and others who offer family planning services to those who need them and who attempt to overcome the resistance to or non-use of family planning services by reason of ignorance or misunderstanding or financial or social circumstances.

In this kind of debate, I am not sure how correct it is to discuss the f[...]nancial priority to be given to this kind of work within the National Health Service and its associated services—

Mr. Speaker

Order. The hon. Gentleman can talk about the finance so far as it concerns the Supplementary Estimate which makes provision for what he is discussing.

Mr. Fraser

Perhaps I might put it this way. I believe that the extra money being provided as a result of the increased interest in the use of family planning services by the National Health Service is well justified. It deserves additional priority, and extra money is merited.

Expenditure on family planning services is not a waste of money. In the long run it is not even an additional expenditure. For example, there are those local authorities which work with the Government under the provisions of the National Health Service (Family Planning) Act, 1967, introduced by my hon. Friend the Member for Bebington (Mr. Brooks). There are others which so far have failed to introduce family planning services on the ground that they are short of money or, as is hinted in the annual report of the Department of Health and Social Security, because of financial stringency. People who think that they are saving this money are as foolish as the man who says that he cannot afford to pay an insurance premium because he is already spending his money paying up accident damage. In the long run there is a great deal to be saved by means of extra expenditure on family planning.

To give one example of the sort of saving which can be made, my own borough spends £17,000 on family planning in a year, yet it probably spends over £100,000 a year to deal with children who are in care and the other social consequences of unplanned families and unwanted children.

To give another example, perhaps I might quote from an article in Local Government Finance by Mr. Caspar Brook. It ends: Even if we ignore the special costs of coping with delinquents, criminals and other misfits, the bill paid by tax and rate payers for unwanted children now amounts to £100 million a year. This is certainly a gross under-estimate; even so it is no less than four times greater than the £25 million a year it would cost to give protection to all those women who do not want babies in that year. The long-term saving in terms of money must now be irrefutable. Each pound of public money invested in family planning saves at least four for other purposes. What better investment can councillors and others who can take the decisions to provide family planning services make on behalf of the rate payers they represent. Of course, this is done in conjunction with the Department of Health and Social Security.

I am glad that there has been some increase in expenditure, and I hope that my hon. Friend will assure us that financial reasons will not be advanced for not going even further with the policy which has been pursued so far.

There are a number of points which I want to put to my hon. Friend. To show where the money goes, perhaps I ought to describe the present family planning arrangements. They can be local health authority family planning services. So far, I understand that about 44 authorities out of over 200 operate unrestricted family planning services. Many of them do it by delegating their duties and employing the Family Planning Association or another agency to shoulder the work for them. Then there are the Family Planning Association and the other voluntary services, all of them run in conjunction with hospitals. At King's College Hospital, in my constituency, members of the Family Planning Association interview women and provide them with pamphlets on birth control so that they can talk to their husbands about it. That is sometimes important. They follow up with domiciliary visits. Generally, they find that co-operation with the hospitals is good and that the knowledge of birth control is spread effectively to far more people than could have been dreamed of before.

The real heart of the problem is borne out by a recent article in the supplement to The Sunday Times which published a number of league tables. They showed that 57 per cent. of married people use birth control. Of those who do not, something like 40 per cent. are in what are known as the lower social classes, where there is some difficulty about getting birth control to those in need of it. From figures supplied by the Family Planning Association, only a small percentage of those using the association's facilities come in what might be called the lower social classes. That means that family planning techniques and advice are not getting through to those who really need them. As is so often true in life, those who are least equipped to deal with difficutl social problems are often those with the most difficult problems.

I am strongly in favour of the provision of these services to people who need them so badly, but I want to ask a number of questions about the way in which the money is used. To what extent is the money going by way of additional grant to local authorities for making use of their powers under the 1967 Act? To what extent is that increased expenditure by local author-ties being used to provide domiciliary services?

Will any part of the expenditure be used to educate not only those who need birth control but the councillors who have to put schemes into effect? It is not so much a matter of teaching councillor the facts of life; it is a matter of teaching them the facts of other people's lives. Has the Minister in mind the holding of educational conferences for councillors and others concerned with the implementation of birth control advice with a view to educating them to the advantages which can be gained from it?

Perhaps my hon. Friend might take as a text a statement from the pamphlet issued by the Health Education Council. Dealing with health education generally, it says: The Council does not accept the widely held assumption that if people are informed by pamphlets, posters, press articles, broadcast programmes, etc., of the dangers to their health of doing this or of not doing that, they will automatically respond and take the necessary … action.

Mr. David Steel (Roxburgh, Selkirk and Peebles)

If the hon. Member is encouraging the Minister to hold such meetings, would he also recommend to him that among the invitees should be the Secretary of State for Scotland. who so far has not implemented the legislation at all north of the Border?

Mr. Fraser

Yes. I said it might go beyond councillors, and certainly there is a vote here for increase in support in Scotland. I was hoping there would be an announcement that some part of that money would be used to provide those facilities in Scotland which are at present available and can be provided in England.

I hope that part of this increased expenditure will be spent on educating those who are bringing it into effect—not only councillors but the medical profession, midwifery and other services—and who have direct contact with those who are in need of family planning advice.

I ask next to what extent the increased expenditure will be disbursed. Regarding advertisements, despite what the Health Education Council said, one has to have the advertisement, the information, and the follow-up. To what extent will the increased expenditure be spent on posters—one of which is well known and appeared in the newspapers recently, the pregnant man? Is any part of the money for increased expenditure to be spent upon television advertising of birth control? I do not mean advertising in the commercial sense, but responsible public announcement-type of advertisements which can bring home to people the facilities which are available for them and which are being expanded by the Department of Health and Social Security.

Recently there was a very successful and well produced programme by the B.B.C. on domiciliary birth control services, something which would have been of immense interest to people who need family planning advice, and which would have opened the eyes of a good many people. It showed that someone could visit a very difficult case, perhaps a woman who has several children and cannot find her way to the family planning clinic. Unfortunately, that programme was after midnight. I hope it is not trite to suggest that birth control programmes after midnight may be too late. What I am therefore suggesting is that the sort of response and sympathetic approach that was pursued in that programme by the B.B.C. should be adopted and should be distilled and used in public service-type announcements. Perhaps "advertisement" is the wrong word here; it gives the wrong impression. Is any part of the increased expenditure to be used for this purpose?

I want to ask whether, under the increased administration expenses for health executive councils and for hospitals, money will be devoted directly by way of grant to the Family Planning Association. At the moment, out of their income of £3 million, about 12 per cent. comes from local authority contributions, and a very small percentage comes for pure training facilities for people working in National Health Service hospitals. How much additional expenditure will go into, for instance, reimbursing those who attend hospital for the Family Planning Association and pass pamphlets and literature on to the patients, who follow up with home visits, and having families of their own, talk to them like people? They also talk to people of like mind in the same neighbourhood, and are able to put their minds at rest and answer queries which they might have about family planning. Are direct grants to be paid to those people? They need only be modest; perhaps only to reimburse them for their expense, or the cost of having their own children looked after during the morning while they do this work at the hospital. Is any part of the money to be paid to them by way of direct grant or individual payments to Family Planning Association workers?

I want to ask next whether any part of the administrative increase in the National Health Service will be for the production of pamphlets and literature which can be made available for G.P.s. The general practitioner has a very important part to play in the provision of family planning advice. But anybody who spends any time at all in the surgery of a National Health Service doctor will realise that he is over-burdened and he has not always got the time, not only to talk to the woman who may come for help and advice, but to talk to her husband as well. Is money to be made available for the production of literature and pamphlets and other work on family planning for doctors? Also, does any part of the increased expenditure on drugs anticipate the fact that the Minister will now allow doctors to prescribe, both in medical and non-medical cases, birth control advice and drugs for women who go to their family doctor?

As I understand the position, until recently it could only be prescribed on medical grounds. That is an artificial distinction. It is very difficult; one would need to go into somebody's house, if they are in poor housing conditions, and make a very thorough investigation indeed, to distinguish whether ultimately it was a medical, a social or a purely nonmedical need. I am wondering whether the increase has been caused by the fact that doctors will be allowed a much wider discretion to prescribe in non-medical cases.

I want to ask also whether any part of the increased expenditure is in anticipation of the proposals in the Green Paper on the reorganisation of the National Health Service, where it is proposed that area health authorities should take over the functions now performed by local authorities—or now not performed by local authorities—in providing family planning advice and services. Only a little over 40 of 204 local health authorities provide unrestricted facilities, and perhaps the Minister has it in mind that in those areas where the services are not provided by local authorities the National Health Service, in anticipation of decisions on the Green Paper, would take over the job directly, and institute the facilities or arrange them in conjunction with the Family Planning Association.

I suppose that in asking for these things to be done one is pushing at an open door. It is very pleasant to be able to say that. There is no hint or word of criticism of my hon. Friend the Minister, nor of the Secretary of State for Social Services, who, in a recent address to a Select Committee—I have forgotten which one for the moment—advocated free contraception on the National Health Service. Not everybody wants free contraceptive advice. If one looks at the people in the higher social classes—again I hate that expression—who now use birth control and can afford to pay for it—and in my opinion will continue to pay—and one takes that into account, the expenditure is probably very much less than the figures put forward by the Secretary of State for Social Services or by members of the Family Planning Association. I hope that the Minister will be able to reassure us on the things I have asked.

In conclusion, there is a great deal of misunderstanding when one reads statements by the Minister in support of increased expenditure, and articles in newspapers and journals by members of the Family Planning Association, and other advocates of the use of family planning. There is a misunderstanding that one is trying to prevent people having children at all. It is none of our business, none of the business of the Ministry, local authorities, or anybody else, to tell people that they must use family planning. All the Ministry and anybody else is advocating is that the free choice should be made available and knowledge about the free choice should be provided. After that, it is up to the people to choose.

It is often a question not of getting rid of unwanted children but, as the phrase denotes, of planning properly and preventing the kind of situation which I come across so often as a constituency Member, of people moving into a small flat which is adequate for a married couple, slightly inadequate when they have one child and grossly inadequate when they have three children. Such people can fall below the threshold of hope of obtaining better accommodation. It is a question not of getting rid of unwanted children but of deferring the time when the children can properly come, so that they have a happy and full upbringing.

Therefore, I hope that this misunderstanding will not persist, and that the Minister will not only be able to assure us on the things I have asked about but also give us some information about his plans for expanding family planning services and the encouragement of statutory and voluntary services.

6.51 p.m.

Mr. Peter M. Jackson (High Peak)

My hon. Friend the Member for Norwood (Mr. John Fraser) is to be congratulated first on taking the initiative in raising this matter and secondly on the able way in which he has spoken. He said so many of the things that I wanted to say that I have a certain reluctance to speak. Nevertheless, I should like to reinforce some of his points.

I should like to draw the attention of my hon. Friend the Under-Secretary of State to the laggardly and disgraceful attitude of local authorities, so many of which have refused to exercise the powers which they were granted under the Act brought in by my hon. Friend the Member for Bebington (Mr. Brooks). I am not exaggerating when I say that perhaps no more than 25 per cent. of the local health authorities of England and Wales have provided a fully comprehensive and adequate family planning service.

Of course, north of the Border, as my hon. Friend knows, the services, outside Aberdeen and one or two other cities, are extremely limited. I agree with my hon. Friend that it is time that the Under-Secretary of State had earnest and pressing conversations with his opposite number in the Scottish Office and suggested to him that the time was right to bring in an order allowing local authorities in Scotland to implement the Act.

We are dealing here with a very serious problem. I know very well that my hon. Friend is aware of it, but I wonder just how many members of the general public and how many hon. Members are aware of it. Of course, it is difficult to estimate precisely, but about 200,000 unwanted children are born each year. That is the scale of the problem and the tragedy. We can tabulate the more manifest aspects of this problem, in that we know how many children are taken into care.

In this context, I draw my hon. Friend's attention to a document, which I am sure he knows very well. It is the report of Sir George Godber on the state of public health, in which he estimates that about 20,000 children are taken into care each year and says in paragraph 5.63 that these children are unwanted children. Given the data provided by my hon. Friend on the birth control practices of the English population, it is hardly surprising. About 38 per cent. of those people questioned in the very extensive survey by Mr. Geoffrey Gorer, reported in last Sunday's Sunday Times, practice no form of birth control at all. That seems incredible in this day and age, but those are the figures and the number of unwanted pregnancies which I quoted shows that that figure is by no means an exaggeration.

I reinforce my hon. Friend's point, that we should spend far more on propaganda. In this context, I welcome the admirable poster produced by the Council for Health Education, drawing attention to the responsibility of men for birth control. I am sure that hon. Members will agree that far too many men regard the responsibility for birth control as one for women alone. I should like to see the message of this poster brought home to more and more men.

But the budget of that body is very limited. This message will not get on television, as it should. In The Guardian last Saturday was a comment by an advertising executive, a Mr. John Hobson, who I understand is this year's chairman of the Advertising Association. He drew the nation's attention to the derisory sums which we were spending to counter the £5 million-plus which the tobacco industry spends to encourage people to smoke—or, as I prefer to put it, to commit suicide. He went on to argue that an effective campaign of health education would cost at least £1 million.

The Under-Secretary cannot spend that kind of money, nor can the Council for Health Education, but I hope that he will devote a percentage of the additional funds to be spent in this field on propaganda of this kind. It is expensive. The Family Planning Association has been advised by its technical adviser that a minimal campaign would cost £99,000—a large sum of money. I hope that, when my hon. Friend talks to the Treasury, he will draw to their attention the opinions of advertisers and of the F.P.A. and will press the point that limited sums spent on advertising are quite ineffective.

I should like the message of family planning brought home to people through the medium of television. The I.T.A. at one time had a very restrictive attitude to family planning. The subject was not thought appropriate for appearance on the media—

Mr. John Fraser

But sex is.

Mr. Jackson

Yes, sex is, but not family planning.

But the I.T.A. has changed its view, I am glad to say, and is prepared to take discreet advertisements drawing attention to this need. But what can the Council for Health Education do? It can only, through the Central Office of Information, produce "fillers" which will take their place in the 100 other fillers which appear in the public service section of commercial television. These, I am informed, appear on Saturday at 12.30 p.m., 1.30 p.m. and 5.30 p.m. That is hardly popular viewing time, and even though the C.O.I. may give priority to that form of advertising, it is obviously ineffective.

I should like to deal with the need for educating the young in the techniques of family planning. We all recognise the trend. People are marrying far younger. Perhaps it would be appropriate for my hon. Friend to consult his opposite number in the Department of Education and Science, with a view to considering the possibilities of giving family planning information education—

It being Seven o'clock, and there being Private Business set down by direction of The CHAIRMAN OF WAYS AND MEANS, under Standing Order No. 7 (Time for taking Private Business), further Proceeding stood postponed.