HC Deb 26 July 1972 vol 841 cc1979-89

11.15 p.m.

Mr. Monro

I beg to move, Amendment No. 5, in page 4, line 17, after 'subsection', insert '(except advice on contraception)'.

Mr. Speaker

With this Amendment it will be in order to discuss Amendment No. 4, in page 4, line 15, leave out subsection (2).

Mr. Monro

The hon. Member for Glasgow, Craigton (Mr. Millan) pressed very firmly in Committee for this clarification to be made to the Clause. Although the Government's full-scale review of family planning services has not yet been completed, it can be said without reservation that it has progressed to the stage where it is clear that a power to charge for advice will not be used and is not needed. Modification of the Clause as proposed does no more than confirm settled policy, but nevertheless will be welcomed as evidence that the Government accept family planning as an integral part of a comprehensive health service.

Dr. Miller

We must thank the Under-secretary for writing these few words into the Bill. They indicate clearly the way in which the Government are thirled to the concept of free advice on contraception.

Having said that, I must point out that that is not quite the full story of what we want. In Committee we had a fairly wide-ranging debate on the Clause. In that debate it was made quite clear that there has to be an even more positive attitude on the part of the Government in respect of the whole range of family planning facilities. When patients consult their doctor about family planning, it is not enough that the advice which they receive should be free. In any case, that applies generally in the health service. The patient will say, "It is all very well that you should give me free advice. I am entitled to that. That is no skin off my nose or your nose. That is what you are paid for. I pay my taxes in order to receive free advice."

But what about the prescription? Here is the rub. The Government are being very narrow in this matter. They are seeking to save a very small amount of money. It is only money that prevents them from providing all the family planning services; not merely the advice aspect but all the services, the pill, the appliances, and so on, should they be necessary under medical supervision. The Government are being very shortsighted in this matter. It does not take a mathematical genius to calculate how much money will be saved at the end of a particular year or over a few years if the total necessary family planning provisions are made. I need not spell it out—the prevention of pregnancies, the avoidance of admissions to hospital and calls on the whole range of post-natal care, and so on.

It is short-sighted to imagine that one will save money in this way. Money will be lost, not saved. What is more important, it is precisely those who are not able or willing to spend the relatively small sums necessary for family planning necessities to whom we should be directing our attention. The service is lauded as being available to the public, but when they go to use it they find that they have to pay and it is not the free service which they expect.

I am sure that the Government are looking at the matter only from the financial standpoint. There are hon. Members who feel that family planning is a private affair for which people should be prepared to pay. But that is another argument, and the Government do not take that view. They believe that money can be saved by asking people to fork out of their own pockets the small sums necessary to effect a comprehensive family planning service.

In Committee, I declared not just an interest but, so to speak, a specialty interest, and I was chided by the Chairman for so doing. I am a family planning consultant, and in the clinic which I run in London I see many patients who would be prevented from using the full resources of the Family Planning Association if they had to find the money to purchase the necessities for full contraception.

I ask the Government not to be so short-sighted in their approach. The Minister is not just sympathetic to the idea; he is completely in favour of a comprehensive family planning service, He must therefore realise that he is acting against the best interests of the development of the service by asking for payment.

This falls into a slightly different category from the attitude of the Under-secretary and the Government to charges and payments in the National Health Service. I shall not discuss the question whether the NHS should be free. We on this side of the House feel that there should be no payment in the service, but, assuming that we accept that there must be payment, it is stupid to ask for payment in this sector of it. If the Government ask for payment to be made, they are almost certainly ensuring that they will have to spend more money than they would spend if the service were free. I ask the Under-Secretary to think about that. I am sure that if he thinks of it in a completely detached and objective way he will realise that the best way of saving money in the service is to make not only family planning advice but family planning appliances completely free.

Mr. David Steel (Roxburgh, Selkirk and Peebles)

I touched on this subject on Second Reading, and I read with great interest the report of the Committee proceedings on the Amendment similar to the Amendment in my name and that of my hon. Friends which was moved by the hon. Member for Glasgow, Kelvin-grove (Dr. Miller). I recognise that the Government have made a gesture in their Amendment, but it is only a gesture, without a great deal of substance. I do not ask the Government to accept off the cuff the Amendment in my name, but I do ask them to undertake to reconsider this matter before the Bill reaches another place.

Since the Bill was published, there have been four major reports on the subject of family planning which should influence, if they have not already influenced, the thinking of the Scottish Office and the Department of Health and Social Security. We are entitled to ask for further information on this matter. There is no doubt that, as a result of the Government's Amendment, while family planning advice would be free of charge—and, as the hon. Member for Kelvingrove said, it is already in substance free of charge—if the advice were given on social grounds and it advocated contraceptive appliances, the patient would have to foot the bill.

I could cite many examples, but I had a letter a few weeks ago from a married woman in Jedburgh, in my constituency, who has to travel to Hawick for the nearest family planning clinic. She pointed out that the cost of one visit to the clinic in terms of the amount she has to pay for the provision of the next few months' supply of the "pill", plus the bus fare, and not to mention the time lost in carrying out her family responsibilities, was about £5, For a family living on a small weekly wage of about £15, as in this case, that it a very-large amount.

The Government are determined to press ahead with the family planning campaign, but that campaign would be very much effective later this year if it were backed by a forward-looking policy which recognised that family planning appliances and services, as well as the advice, should be free.

11.30 p.m.

I referred to four major new reports which have been forthcoming since the Bill was published in February. I should be very interested to know from the Under-Secretary how may of those have been studied by the Scottish Office, because I suspect not all of them have. The first I refer to is the report of a working party of the Royal College of Obstetricians and Gynaecologists under Sir John Peel. It reported in February this year, the same month as the Bill was published. It was a very distinguished body. I do not think anyone would say it consisted of outrageous radicals. In page 91 of its very sober report on contraception and abortion the working party said: We strongly recommend that a comprehensive contraceptive service should be established within the National Health Service. There should be no financial disincentive to the provision of advice and services by any doctor working within the National Health Service. That is a very weighty report, and I trust it has been considered by the Government.

In Committee the Under-Secretary was challenged on how much it would cost to have a completely free family planning service, with appliances and services free. With a proper sense of reserve, he admitted that this was a question of judgment. What he said was: The figure which has been suggested in discussions"— a nice vague phrase I rather like— ' "is that it might cost £4 million more in Scotland alone."—[Official Report, First Scottish Standing Committee, 23rd May 1972; c. 118.] It is difficult to argue on the arithmetic, and I do not propose to do so tonight, but let us accept for the moment the figure of £4 million to be correct. There are two further points which must be considered. A report, also, as it happens, published in February this year, by the independent group, Political and Economic Planning, contained a very interesting study which concluded: It seems particularly desirable that local authorities should consider the total benefits of investment in family planning. At present the costs of family planning are generally laid on the health committee's budget whilst other committees' budgets benefit from its provision. That, I think, is the answer to the Under-secretary when he said that if we had no charge for social reasons, it could only be at the expense of other requirements within the National Health service."—[Official Report, First Scottish Standing Committee, 23rd May, 1972; c. 117.] One has to look at the actual budgeting of the service itself when considering the cost benefit of the family planning provisions. On page 2 of the PEP report there is an interesting table. I do not by any means accept the figures as gospel, but they are an interesting study which attempts to tabulate the cost per unwanted child prevented during the current year, and the benefit-cost ratio. What is said is that the cost per unwanted child prevented in the current year would be about £34—this is for the fourth child which might be born to a family—whereas the benefits, by preventing that unwanted birth, are calculated at £675, a benefit-cost ratio of 20 to 1. I do not want to go into all the figures, because the Government can examine them themselves, but this study, moving to the illegitimate child, says that, as against a cost figure of £34 a year, the benefits are estimated at £4,352, a benefit-cost ratio of 128 to 1.

This report deserves very considerable study.

Dr. Miller

Would the hon. Member accept, though, in order that the public does not get the impression that Parliament wishes to prevent children from being born if people want them to be born, that this is a matter which we feel should be left entirely to the people concerned, and that it is a matter of making family planning facilities available to those people who want them? If people want to go ahead and have children, we are not objecting to the cost which would have to be borne by the State.

Mr. Steel

I entirely agree with what the hon. Member says. I am trying to set this argument in the context of the Under-Secretary's argument in Committee that, according to him, if we spent more money from the National Health Service budget on what we are asking for, savings would have to be made elsewhere. That is not true, because one must look outside the National Health Service budget for the savings that would be shown.

My third quotation is from a report published in April this year by the Office of Health Economics entitled "Family Planning in Britain". It states: The potential benefits from a comprehensive family planning service lie in the prevention of these sometimes disastrous, personal, social and economic consequences of the birth of unwanted children. Real and tangible benefits can clearly be derived from raising the quality of life of both parents and children. Again, that is a report which, I hope, has been or will be studied by the Government.

The last of my four quotations, the most recent of all, is from last weekend's annual representative meeting of the British Medical Association held in Southampton. I do not think anyone would accuse the BMA of being irresponsible, adventurous or outrageously radical in this matter.

That meeting passed two interesting resolutions. The first was simply That a national and uniform family planning service should be set up, including the provision of free planning advice and equipment by general practitioners. Its second resolution was That the conference views with concern the general public disregard for personal and social responsibility manifest by the high rate of abortion and urges the Government without delay to institute programmes (a) to educate the individual in a responsible attitude towards overpopulation, (b) to provide comprehensive family planning under the National Health Service; and that additional money be made available to finance these programmes. I say again that in the face of these very weighty reports and views that have come forward since the Bill was first drafted, we are entitled to say to the Government: "Do not make any hasty decisions tonight but please undertake to us that you will study these reports and that in another place you will consider yet again the Amendments which we have been pressing on the Government to remove from the Bill the quite outdated and antiquated idea that somehow there should be power to charge for family planning in the new forward-looking health service which we hope to establish in this legislation."

Sir John Gilmour (Fife, East)

The giving of advice referred to in my hon. Friend the Under-Secretary's Amendment is an important matter but it is unfortunate that it appears in brackets, as if it were an afterthought and not important. It is very important, and, if anything, I should like to see it underlined. I wonder why it appears in brackets.

Mr. Carmichael

We are pleased with what we have got from the Government although, naturally, we would have much preferred the Amendments we suggested in Committee to have been accepted. The points made by my hon. Friend the Member for Glasgow, Kelvingrove (Dr. Miller) and by the hon. Member for Roxburgh, Selkirk and Peebles (Mr. David Steel) had a great deal of validity and I hope that the Minister will give a great deal more study to the matter.

I would say to hon. Members who have spoken that I do not regard the Government's Amendment as unimportant. While I should like them to go a great deal further, this is a large step forward, and I hope that the rate of progress will be increased. Even over the last five years there has been a considerable change of attitude. I am glad that the Government have put down the Amendment, and I hope that it bodes well for the future. There are powers in subsection (2) which enable the Government at any time to decide that the service shall be free.

As amended, Clause 8(2) would read: Regulations may provide for the recovery of charges from persons availing themselves of any service under the foregoing subsection (except advice on contraception), and may provide for the remission of any such charge, in whole or in part… Will the Minister say what is meant by "advice on contraception"? Is he suggesting that consultancy fees will be paid to consultants who work with the Family Planning Association? Will health boards be directly empowered to pay consultants working in Family Planning Association clinics or is the intention that area boards will ultimately take over the functions of Family Planning Association clinics? That may be desirable in certain parts of the country but the work of the F.P.A. deserves recognition and in many parts of the country the F.P.A. may be the best organisation to do the job.

Aberdeen, through the local authority, provides free an extremely comprehensive family planning service, including both advice and appliances. Local authority health service duties are to be taken over by the area boards. Where an area has a high and progressive standard of family planning advice, will the Minister confirm that that area will not be made to conform to an all-Scotland standard put out by the Department? Will the health board take on the job at present done by the local authority and provide a less comprehensive service?

There are areas in which the local authority has not provided such a good service as has Aberdeen, and the Government may therefore set standards which are considerably lower than the best at present provided. We want the whole of Scotland to have the best, but may we at least have an assurance from the Minister that there will not be a reduction in standards to comply with a lower standard of unformity which may be administratively easier? Will the Minister also give us a bit more hope for the foreseeable future on Amendment No. 4?

11.45 p.m.

Mr. William Hannan (Glasgow, Maryhill)

Although I accept the general spirit that lies behind the Amendment, may I try to change the emphasis of this discussion? It seems to me that there is a call for more self-discipline in these matters, whether it be in terms of the size of families or in other respects such as the consumption of liquor. Is not the Under-Secretary of State being urged to devote resources to dealing with the effects of human actions rather than to the matter of prevention? In other words, has not the permissive society gone much too far? For example, in the light of the excess consumption of strong liquor society is asked to provide special drying-out clinics. This seems to me to be all wrong. Therefore, in future we in society must direct our thoughts to prevention rather than to allocating expenditure in trying to rectify human excesses in one respect or another.

Mr. Monro

I am grateful for what has been said about the Amendment and for the fact that we have had a constructive debate. The tone of the debate reflects the fact that the Government are conducting a full-scale review of the family planning service—a review which has not yet been completed. The review takes account of such publications as those mentioned by the hon. Member for Roxburgh, Selkirk and Peebles (Mr. David Steel); I have read them and I know that they are very valuable indeed. They are certainly being considered in the major review which is now going ahead.

We must also accept that family planning is a relatively new service in Scotland and, I am glad to say, is developing fast. At present 52 out of the 56 local authorities provide some form of family planning facilities.

Advice and treatment at the clinics for medical reasons is free. As the Bill stands, there will be no charge for treatment or for appliances for social reasons unless regulations are laid before the House to allow for charging. This will have to be done before April, 1974, if charging is to take place subsequent to the appointed day in the Act. Therefore, long before then the Government's review will have been completed, and in the light of the decisions we shall have to see whether it will be necessary to lay regulations before the House to provide for charging.

As hon. Members know, at the moment the majority of local authorities charge for the facilities that they provide, though not in the case of Aberdeen. In thanking the hon. Member for Glasgow, Woodside (Mr. Carmichael) for his remarks, I ought perhaps to point out that if the advice of a consultant is required for a special case at a family planning clinic, that is provided free. I join the hon. Gentleman in paying tribute to the work of the Family Planning Association throughout Scotland. As the hon. Gentleman said, the present responsibilities of the local authorities will be taken over by the health boards, and I have no doubt that areas such as Aberdeen which have very comprehensive family planning clinics at the moment will continue to do so under the health boards.

The hon. Member for Roxburgh, Selkirk and Peebles has great experience in these matters. I ought perhaps to point out to him that the whole tenor of our debates in Committee was directed to our desire to see a really comprehensive and effective family planning service in Scotland. I appreciate his point about cost-effectiveness. However, we have looked at it always more positively from the standpoint that we do not want to see unwanted children born if it can be prevented by giving advice at the right moment.

The hon. Member for Glasgow, Mary-hill (Mr. William Hannan) mentioned the importance of self-discipline. This is part of the theme that will be developed in the publicity campaign that we shall be launching in Scotland during the coming autumn.

Dr. Miller

I hesitated to intervene when my hon. Friend the Member for Maryhill (Mr. William Hannan) was speaking. I caution the hon. Gentleman not to labour this point too much. Unwanted children are not alway the result of lack of self-discipline or lack of self-restraint. Although I commend my hon. Friend's comments on this, perhaps he is unaware of the human mechanism: it is quite possible for a couple to restrain themselves and yet to produce children, and for another couple not to and to produce no children.

Mr. Munro

This discussion is becoming rather technical. But I am surprised that the hon. Member for Kelvingrove reckons that he knows more about the facts of life than the hon. Member for Maryhill.

We are determined to have a first-class family planning system in Scotland, and it will be the responsibility of the Secretary of State, carried out by the health boards. I hope that hon. Gentlemen will accept the assurances that I have given that the Government are involved at the moment in a very detailed full-scale review of the family planning services and that, at the end of the day, they will find that there is a service for which the whole country will be grateful.

Amenement agreed to.

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