§ 10.9 p.m.
§ Mr. Peter M. Jackson (The High Peak)
Before the debate on the Consolidated Fund Bill was interrupted, I was drawing my hon. Friend's attention to the need to take more seriously educating the young in the techniques of birth control and responsible parenthood. There is general recognition throughout the House that our schools, our institutions of education, should provide training in road drill, because we recognise that unless children have a traffic sense, unless they know their highway code, as pedestrians, cyclists, or even as motorists, they are endangering their lives.
Similarly, we should give even greater priority to family planning. The statistics produced by Sir George Godber show that there is great ignorance and prejudice results from the ignorance of birth control techniques. I qualify that statement by saying that it is not just a question of ignorance. Often, or at least sometimes, the appropriate motivation is lacking. I hope that more attention will be paid to this.
I say that, knowing that the Ministry will use the F.P.A. as its agent in family planning. I welcome this, but I have had some correspondence with the Secretary of State on the attitude of some local F.P.A. branches towards birth control advice to the young and the unmarried. Some local branches have been less than helpful. I hope that the Department will make it clear—I know that they are doing this—that, if the F.P.A. is to be the agent, there must be no discrimination against the young and unmarried.
741 The next point I wish to raise concerns the sense of embarrassment which many young women feel when broaching the subject of family planning with their general practitioner. In this context, a survey was reported in the Sheffield Morning Telegraph among young women in a North Derbyshire pit village is of interest. It was undertaken by the Shirebrook Amenity Society into the general amenities of the village. One of the most revealing facts was that many women were reluctant to go to the general practitioners in the area, because they were known to be Roman Catholics. I understand that the amenity society, as a result, made representations to its health executive, suggesting that there should be a Protestant doctor so that women did not feel the embarrassment of approaching Catholic doctors.
I think that this feeling of embarrassment is exaggerated. I know the attitude of the Roman Catholic church, but many Roman Catholic practitioners are liberally-minded, and if they felt unable to give the advice, they would doubtless refer their patients to others who would. But this is a blockage and it is a problem.
My hon. Friend the Member for Norwood (Mr. John Fraser) talked about the rôle of general practitioners. Obviously, this service will be provided in future by the F.P.A. and the general practitioners, but a general feeling in the profession is that doctors should receive some additional remuneration for the assistance which they give patients in respect of family planning. They point to the fact that they are paid for taking cervical smears and to the additional payments which they receive when doing vaccinations. They feel that this additional service should also be paid for.
Some doctors have experienced difficulty in prescribing. I hope that this information will come as a surprise to my hon. Friend: if he knew about it, I am sure that he would see that it was stopped. It has been reported to me by two general practitioners that their regional medical officer has drawn their attention to the heavy prescribing of pills on the form EC 10. I hope that the Ministry will direct that the prescription of pills on the standard form is allowable 742 not only in respect of medically referred cases, but in respect of all cases.
A new development, which I greatly welcome and which I hope others will welcome, is the acceptance by some employers of the need to provide family planning services. I gather that this is—
§ Mr. Speaker
Order. Whether employers accept responsibility is not a matter for the Minister. This is an interesting debate, but it does not cover the whole world.
§ Mr. Jackson
I thank you, Mr. Speaker, for calling me to order. Nevertheless, I would point out that the services are provided by the F.P.A., which in turn receives a grant from the local authority. Therefore, I thought it would be in order, and, with permission, I merely make a passing reference to it.
I would draw my hon. Friend's attention to a clinic held in the factory of Texas Instruments, Ltd., at Bedford. The hours worked by ladies at this factory make it difficult for them to attend the local F.P.A. clinic. Their employers, therefore, thought it proper to invite the F.P.A. to hold a clinic at the factory. This kind of invitation should be widely welcomed. I am sure that my hon. Friend would wish to see an extension of that particular service.
I turn now to the technology of birth control. I am no specialist in this sphere, but I am told that it is almost in the Stone Age. When I compare the money which we spend on technological developments of one kind and another—I think particularly of Concorde—and the amount we spend on family planning, I wonder whether we have our priorities right.
I think it appropriate to mention that Professor Sir Alan Parkes, who is a member of the Advisory Committee on Medical Research, at a recent conference alleged that we are spending more on the problem of infertility than on the whole question of contraception. I think it is absurd that we should be spending so much on such a problem, although I do not suggest that it is not important to some people. Nevertheless, in terms of the wellbeing of the total community, it is absurd that birth control should be given far lower priority than the problem of infertility.
743 I understand that the total turnover of the various drug houses producing the Pill is about £4 million. The Pill has taken a severe knock recently, because there has been a lot of adverse publicity. The companies concerned are seriously alarmed by this and are reluctant to spend the additional enormous sums of money which must be put into further research. They feel that the projected turnover will not justify the expenditure. I suggest that my hon. Friend's Department should think more seriously about providing assistance to the industry for research.
Finally, I draw attention to the debate in the other place on the Green Paper on the Health Service and ask for clarification. The question was raised by the noble Lord—
§ Mr. Speaker
Order. The only reference that the hon. Gentleman can make to a debate in the other place is if it refers to a Minister making an official statement on Government policy.
§ Mr. Jackson
I am happy to comply with your Ruling, Mr. Speaker. I will merely refer to the fact that the Baroness Serota, speaking for the Department, failed to answer a query addressed to her by Lord Addison on the rôle of the area health authorities concerning family planning. I know that this is a matter which concerns my right hon. Friend the Member for Sowerby (Mr. Houghton). I should like to know whether the area health authorities are to be given mandatory powers or enabling powers which will enable them to operate in the way that local authorities operate. I hope that my hon. Friend will confirm that there is to be a statutory obligation on area health authorities to provide a fully comprehensive and adequate family planning service.
§ Mr. Speaker
I remind the House, at the risk of tedious repetition, that this is the third of eight debates we have tonight. Reasonably brief speeches will not be unwelcome.
§ 10.20 p.m.
§ Mr. Douglas Houghton (Sowerby)
can scarcely hope to convince hon. Gentlemen opposite of my point of view. [HON. MEMBERS: "Oh"] Since not one is present, that must be an accurate statement.
744 This is a three Clause Bill. Clause I votes more than £200 million of extra supply for the current financial year, Clause 2 votes more than £800 million for services ending in 1971, and Clause 3 says:This Act may be cited as the Consolidated Fund (No. 2) Act 1970.However, it is traditional, when discussing the Consolidated Fund Bill, to discuss items of special interest to individual hon. Members and to have the opportunity, if necessary, of a very long debate to complete the programme. I will try to be brief, though since I have made some controversial speeches outside the House of the subject of birth control and population control, I owe it to the House to put some of my views on the record of the House.
I wish to put this subject in a wider context, that of population control, because that means birth control for the common good. Few people think of it in that way. The population explosion is believed to be in India and Asia, but not in Britain. Population increase in Britain is thought to be something for which we must provide and not something which we should discourage or try to stop. The positive aims and benefits of family limitation need to be well defined and plainly put across if they are to become accepted in a democratic society as desirable objectives of social and econmic policy.
Whether it is to solve or avert manifest evils of over-population or to improve the quality of life in the fullest sense, they must carry conviction. I frequently say—I have been saying this for years—that party programmes offering economic and social policies for better living, better housing, schools. hospitals, roads, education and social services never mention population control as a means of attaining those desirable ends. No equation between population increase and a higher standard of living is ever offered for public examination, though I am glad to note that my right hon. Friend the Secretary of State for the Social Services has embarked on some studies which may give us this much needed information.
Warnings from the demographers about the rising ratio of dependent old and young go largely unheeded because 745 the underlying philosophy of the political approach is that it is the duty of the State to make itself rich enough to provide a good life for the population presented to it by the mothers of the nation, and that is what economic growth is believed to be all about. No other domestic purpurpose has been included in any party political programme in this country so far.
Birth control for the good of all has hitherto been less acceptable than family planning for personal hapiness and welfare. Indeed, family planning has to be put across mostly as a contribution to a balanced and happy family life, rather than a contribution to population control. The prevailing doctrine seems to be that it is no business of the State to tell us how many children we should have. I think this may logically come within a declaration of human rights, but it cannot easily be reconciled with the assumption of wider and heavier responsibility by communities everywhere for child and family welfare. I do not believe that the economics of family size can be regarded any longer as the sole responsibility of the parents because family size is the business of the State. It is a joint responsibility and mutual benefit can come from it. I think it essential that this doctrine should be accepted.
Political parties and Governments find these matters extremely distasteful. They tight shy of them. They arouse deep emotions, deep personal convictions and religious differences. They are embarrassing and they are bad for party unity, we are told. They are vote losers, we are told. On looking at the record, one finds that the Labour Party at its annual conference has discussed birth control only three times in 40 years, and the Conservative Party conference not at all. Yet it was a Labour Minister of Health in the second Labour Government, the late Mr. Arthur Greenwood, who issued the first historic circular to local authorities on the giving of contraceptive advice. What he did over 30 years ago stood as the sole contribution of Government to this matter until the present Government came into office in 1964.
Then my right hon. Friend the Member for St. Pancras, North (Mr. K. Robinson), then Minister of Health, renewed that historic circular of 33 years ago, reminding local authorities that they 746 have the power under the authority of Parliament to spend money on the provision of contraceptive advice for medical reasons. But it was not until my hon. Friend the Member for Bebington (Mr. Brooks) introduced the Family Planning Bill, 1967, that local authorities were empowered to spend money on giving contraceptive advice for social and not exclusively medical reasons.
If we are to preach the doctrine of family responsibility, social responsibility, the interests of the wider community in making the most private personal decisions, we have at least to enable the community to practise birth control if they are convinced that that is the proper thing to do. They cannot do that if they do not know, or know imperfectly, or cannot afford the means of carrying it out. That is why I feel that from now on advanced thinking on this subject, like that of my right hon. Friend the Secretary of State, should consider placing contraceptive advice and contraceptive appliances on the National Health Service. I think this would popularise birth control in all forms and would enable the Government to back that policy with the fullest advice and practical support.
This is precisely what was recommended by the Royal Commission on Population 20 years ago. One of the most depressing experiences is to read the report of the Royal Commission and to realise how little has been done about this in the intervening period. It is absolutely essential that the Government should sponsor this programme. It is no good leaving this to the initiative of private Members, and the hazards of Private Members' Bills. I congratulated my hon. Friend the Member for Bebington at the time that he introduced his Bill, but I would have been even more pleased if it had been a Government Bill. That would have shown that the Government were putting their backs into it and lending moral support to provisions to widen the scope of local authority services.
We all know how difficult it can be to get Private Members' Bills through this House. My hon. Friend was fortunate in placing his Bill before the House at a time when there was greater acceptance of it than many of us expected. There was no vote on it in this House, there were no Amendments in 747 Committee and there was not even a campaign against the inclusion of the single girl. There were no Amendments or Divisions in another place. That was very encouraging, but the Measure does not go far enough, because it puts the responsibility in the hands of local authorities, some of whom are co-operative, some of whom are positively obstructive.
My hon. Friend the Member for The High Peak (Mr. Peter M. Jackson) asked the Minister whether, in the proposals to transfer family planning services from local authorities to the N.H.S., the service will become universal, provided as part of the Health Service and regarded as an obligation on the area administration of the Health Service. if any Government will bring forth proposals to put contraceptive devices, appliances, the Pill—the lot—on the Health Service, it would be the boldest stroke yet towards achieving happiness for thousands of families, and greater wellbeing in the community at large.
This would probably divide the House sharply on grounds other than political. It would cut across parties but this is not unusual in politics nowadays. I could mention a number of topics when divisions in the House have been across it rather than down the middle. I believe that this will come about, but I should not like to predict that it will happen this Session. When people can free themselves from the embarrassment of relating their deepest personal emotional experiences to the possible consequences of the act of procreation they will be able to accept the sterilisation of physical love as essential to improving the quality of life, quite apart from its effect upon population.
It is a gratifying sign that my hon. Friend the Member for Norwood (Mr. John Fraser) has felt able to bring this subject forward tonight. As the sparse attendance in the House reveals, if we do not have a large measure of visible support, we are free from a large measure of visible opposition. That in itself is a comfort in such a debate and would not have been so a few years ago. I have now done my duty. Many of the things I have said outside the House I have now said inside it and that gives me a great deal of satisfaction.
§ 10.40 p.m.
§ The Joint Under-Secretary of State for the Department of Health and Social Security (Dr. John Dunwoody)
I am grateful to my hon. Friend the Member for Norwood (Mr. John Fraser) for raising the subject of family planning. I think that every one of my hon. Friends who has taken part in the debate will agree that it is a very important subject.
I want to begin by reaffirming that the provision of a comprehensive family planning services for all who need it is the avowed aim of the Government. When I say "all", I mean irrespective of age and married status, and this covers one of the points my hon. Friend the Member for The High Peak (Mr. Peter M. Jackson) made. My right hon. Friend the Secretary of State has made this abundantly clear on many occasions. We regard a family planning service as an indispensable element in the welfare of the individual and the family. It is essential in strengthening family life and preventing marital disharmony, ill-health and in some cases social breakdown. We believe that a comprehensive family planning service, fully integrated with the other community services, would also relieve the burdens, often considerable, which are placed upon other health and welfare services by the physical and mental distress and ill-health which result so often from the lack of knowledge and effective methods of family planning.
I listened with great interest to the contribution of my right hon. Friend the Member for Sowerby (Mr. Houghton). I I agree with him that family planning is not just in the interests of the individual—and it is in the interests not only of the family but in the interests of the community as a whole. It is more than just a purely personal affair, though the personal side is very important.
I was very interested in my right hon. Friend's comments on the whole question of a population policy. He mentioned the historic development that Arthur Greenwood initiated so many years ago. It was the present Government who were the first to go further and give positive encouragement to the provision of a family planning service under the National Health Service. It was in 1966 that my right hon. Friend the Member for St. Pancras, North (Mr. K. Robinson) as Minister of Health first 749 asked local health authorities—by reason of their responsibility for community preventative services—to provide both family planning advice and treatment and publicity by all means open to them, including giving finance and other assistance to voluntary bodies working in this field. Some local health authorities had already begun to take steps to implement this advice when the Family Planning Act, 1967, conferred additional powers on them. I am glad to see my hon. Friend the Member for Bebington (Mr. Brooks) here, because he was instrumental in initiating that legislation.
That Act enabled local authorities to provide direct, or arrange for other bodies to provide, a service for the public generally and not as previously only for those in medical need. We extended the service so that it took into account the social factors as well as the more narrow medical ones. Following this Act, my right hon. Friend the former Minister of health again wrote to local health authorities emphasising the need to provide as comprehensive a service as possible as soon as this could be done and expressing the hope that the extension of their powers would serve as a stimulus to future action on the part of all authorities. He spelt out specifically the need to continue to make full use of the services of voluntary bodies working in the field and to provide a domiciliary service where this was considered necessary. This was a point my hon. Friend the Member for Norwood raised. I think that local authorities are increasingly conscious of the need in certain circumstances for a domiciliary service, and this need will perhaps be more clearly identified as a result of a survey and investigation that I shall mention in a few minutes.
In most cases we know that my right hon. Friend was knocking on an open door, and that the majority of authorities fully accepted the spirit of the 1967 Act.
It is unfortunately the case that the beginning of the real family planning service in the local authority field precisely coincided with the start of the present period of financial stringency. Although I think that some authorities could do more than they do, it remains true that expansion of the service has been constantly regulated by the amount of money available.
750 It is to the credit of many local authorities that we have achieved as much as we have in such a short time. At present all local authorities are providing a service of some kind—this does not mean that I would be entirely satisfied with the service they are providing—with one exception, and in this case the authority concerned has agreed to start providing a direct service next month. I fully accept that in a number of cases the level of local authority provision is quite inadequate, but I know that it will be some satisfaction to hon. Members to learn that estimated expenditure on this service by local authorities in 1969–70 shows an increase of about £150,000 over the expenditure for the previous year.
I accept that expansion by local authorities of their family planning services would bring direct and substantial cost benefit to them, but the problem is that some of the savings can arise only in the long-term, whereas the short-term expenditure involved in the expansion of the service presents difficulties to many local authorities in the current financial situation. I should make the point, however, that we are currently considering the possibility of obtaining information which could form the basis of cost benefit study so that we can analyse the economic consequences of action that may be taken. I emphasise that the difficulties are considerable.
§ Mr. Peter M. Jackson
Would my hon. Friend care to qualify his statement that the saving is only in the long run? The long run in this instance, as has been shown by the cost benefit analysis which has been undertaken into the domiciliary service in both Newcastle and Southampton by my one-time colleague John Peel, is very much in that short run, the short run being no more than five years.
§ Dr. Dunwoody
I did not say—I certainly did not intend to say—only in the long run. I thought I said that some of the savings arise only in the long term, because the benefits that accrue will be with us for a very long period of time.
My hon. Friend the Member for Norwood mentioned the question of the extent to which we are encouraging local authorities. I assure him that my Department does all it can to encourage local authorities to provide a better, fuller and 751 more adequate service. This encouragement is given all the time to local authorities in the day-to-day correspondence we have with local authorities. I do not think that there are any local authorities which are unaware of my right hon. Friend the Secretary of State's views on this matter.
I mentioned a moment ago the question of domiciliary services. I think that local authorities are becoming conscious of the need, but I think we will see the real scope that there may be for these services when we have some more of the results of the investigations we are initiating.
As regards general practitioners it is estimated that the great majority of contraceptive prescriptions—perhaps about 80 per cent.—are given by general practitioners. It is, perhaps, not always realised by many people that the majority of women obtaining a family planning service do so from their family doctors. The question of possible embarrassment has been referred to. I do not say that there would not be cases where embarrassment might arise, for one reason or another. One reason has been mentioned. I speak with a little experience when I say that there are many women who would be happier to go to a doctor who knows them and who knows their family circumstances than to a stranger. Therefore, I think that it works both ways and that there are certain people who will be embarrassed in any given situation and it is perhaps best if we offer alternative avenues along which those concerned can go.
I am sure from my contacts in the profession that the family doctors are increasingly providing family planning advice and treatment. My hon. Friend the Member for the High Peak raised the question of additional remuneration. This takes us beyond the scope of the Bill. I will certainly take note of the points he raised. As to his other point, if he would give me details of the two cases to which he referred where approaches had been made to the individual practitioners about their prescribing, I should be happy to look into them.
The question of literature and publicity material for use by general practitioners in their surgeries and waiting rooms was mentioned by my hon. Friend the Member for Norwood. I am certainly prepared 752 to consider this in consultation with the Health Education Council, on which a primary responsibility devolves in this direction, together with many of the other points which have been raised during the debate concerning publicity and propaganda. They are important points.
Perhaps I might mention one area in which the Department is already giving considerable thought. We are actively considering using our own social security offices throughout the country in appropriate circumstances for the display of family planning posters provided by the Health Education Council.
On the hospital side, my right hon. Friend the Secretary of State has recently written to hospitals about their family planning services. His letter encourages hospital authorities to provide a service of advice to their patients, either directly or by arrangement with a voluntary organisation on the hospital's behalf. My hon. Friend the Member for Norwood quoted a good instance in his part of London where this is being done.
My right hon. Friend has also urged hospitals to co-ordinate their services with those provided by local authorities, general practitioners and voluntary organisations so that a comprehensive service is available for the districts they are serving.
Despite all that I have said, there are gaps in the service. It is particularly for this reason that my right hon. Friend has commissioned a comprehensive national study of the family planning service which will cover all aspects of the service, including publicity. This study, which will be carried out by the Government Social Survey during this year, is designed to find out both whether the facilities now available meet the requirements of the people who use them and also the ways in which they might be improved. To obtain this information, the Government Social Survey will ask people in the sample whether they have obtained advice from local authorities, family doctors, hospitals and/or voluntary organisations and whether they are satisfied with the help they have received. They will also make inquiries of those who do not use the existing services to find out whether other sorts of provision are needed or whether there is no expressed demand for service among these people. This covers 753 the point made about domiciliary services in certain situations.
The answers given during those interviews will, of course, be treated as strictly confidential and the individual questionnaires, which bear no names or addresses, will be seen by no one outside the Government Social Survey Department. I am sure that the House will agree that the survey should serve as a basis for future guidance to local health authorities on the ways in which the family planning service should be developed. Local authorities are extending their services. I am sure that they will continue to do this, but when we get the statistical returns from the investigation—we expect to get the early returns, for the second quarter of this year, by late summer—we will have something firmer on which to base future policy decisions.
The question of technology and research was touched on by my hon. Friend the Member for the High Peak. We are aware of the need for both research on existing methods of contraception and the development of new methods, but this is primarily a matter for the various research bodies concerned. The Medical Research Council is sponsoring studies in this direction. It is co-operating with the Family Planning Association and the Royal College of General Practitioners. They are initiating long-term prospective studies relating to contraceptives generally.
When one looks into this aspect, there is the question of training. The possibility that general practitioners should have additional training has been mentioned. In passing, I would mention that we agreed last year to grant £20,000 a year for five years to the Family Planning Association to expand its training programme for doctors and nurses. It is important that those working in the service should acquire skills and expertise in this work.
I referred to the importance of publicity. It is essential that increased publicity be given to this service to ensure that people have a clear understanding of the various kinds of treatment available, that they are aware of where to go to obtain treatment and that they are encouraged to take advantage of it. The Health Education Council has taken over the health educational promotional 754 activities of my Department and has an important rôle to play in this.
As a first step, it has already appointed an advisory panel on sex education whose priority task will be to consider the problem of educating the public in the use of all kinds of contraceptives. It will also be asked to advise on the extension of training and education of professional and lay workers in health education. The promotional activities of my Department are now vested in the council which is giving this work top priority. Encouraging local authorities generally further would best await the initial results from the survey which I have mentioned.
Television advertising has been mentioned. This is being considered by the Health Education Council which is examining the possibility of preparing "fillers" on this subject. It is an expensive form of publicity and one has to compare its effectiveness and that of other forms of publicity. But I certainly would not want to prejudge any decisions which are rightly the prerogative of the Health Education Council.
My hon. Friend the Member for The High Peak spoke about youngsters in schools and the links between the education departments and my Department. My Department has a continuing dialogue about the whole of health education with the Department of Education and Science.
Family planning is one of the personal health services intended to become the responsibility of the new health service authorities, the new area health boards proposed in the Green Paper. I cannot anticipate the Green Paper structure, but, as hon. Members know, except for three specific proposals spelled out early in that document, it is a discussion document. It is to be debated on Monday and it will be discussed in the country in the next few months and succeeded by a White Paper which we hope to publish in the summer months. But I have very much in mind what was said by my right hon. Friend the Member for Sowerby and my hon. Friend the Member for The High Peak. In the context of family planning, the permissive powers needed and the sort now in operation in local authority work are not characteristic of the National Health Service.
755 It is likely that in future there will be emphasis on the provision of a service through the community health or group practice centre used by a number of doctors and other health workers and providing a useful focus for the spreading of knowledge and advice about family planning and staffed by family doctors who have received training in this work and supported as necessary by nurses and health visitors. The latter will no doubt concentrate particularly on seeking to persuade a far higher proportion of mothers with low incomes and large families to attend for advice. One of the problems which has emerged in the debate is that as we devise means by which we 756 provide advice we make it more readily available to those who least need it while the very groups in our society who most need it are the very last to know where to go to get it.
These future possibilities for family planning are in line with the policy of encouraging the provision of preventive services by a single community care team. Whatever the future may hold, I hope that it goes without saying from the extent of the activity which I have described that we have all aspects of the family planning service under constant review and that our eventual aim of a free, across-the-board service is constantly before us.