HC Deb 24 March 1972 vol 833 cc1877-912

Any circular issued by the Secretary of State with regard to services to be provided by local health auhorities under this Act shall be the subject of regulations made in the form of a statutory instrument, a draft of which shall be laid before Parliament.—[Mr. Fell.]

Brought up, and read the First time.

Mr. Fell

I beg to move, That the Clause be read a Second time.

Basically the reason for the new Clause is to make sure that Parliament has a fairly tight rein on the whole Bill when it becomes an Act, which I pray it will not. The difficulties of the Bill are manifold. When this poor creature was considered in Committee, far from being improved it was emasculated and all the safeguards were taken out of it. I understand the reasons for that, but unfortunately it has not been possible to put down Amendments on Report which would have the effect of putting back the two major safeguards. I know that I cannot talk about them because they were disposed of in Committee and I can discuss them only in passing.

The Bill is that much worse now since it does not include the very safeguards which the hon. Member for Derby, North (Mr. Whitehead), the sponsor of the Bill, saw fit to include. In Committee, by what we thought was almost a mistake, an Amendment was agreed to which left out of the Bill what had been proposed by the hon. Member for Derby, North, I think much to his grief. Therefore, this poor thing which is before us this morning does not contain the necessary safeguards for those who might come under the knife.

The new Clause is designed to give protection. The country is undecided on the question of vasectomy; it has had no chance to be anything else. The grave issues that led to the Prime Minister's statement this morning have had the effect that no newspaper during this last week has contained any letters or articles on the subject of vasectomy—

Mr. Marcus Lipton (Brixton)

There was a very full article on the subject in yesterday's Daily Mirror which included an item by a man who had submitted to a vasectomy operation.

Mr. Fell

I am grateful to the hon. Gentleman for drawing my attention to that article, which I am sorry not to have seen. I imagine that the article only gave one side of the case, the case for the introduction of vasectomy under the National Health Service.

Mr. Lipton

Not altogether.

Mr. Fell

One thing which is certain is that it did not mention the other side of the case.

The public do not know very much about this subject and must be protected from following advice to have a vasectomy without having had the opportunity of being fully informed about the effect of it. We have had no experience of the result of vasectomy operations. The Simon Trust produced a great document but it is not medically acceptable. All those who were interviewed had had the vasectomy operation only a short time before being interviewed, but the effects of the operation should be considered over 10 or 15 years. Meanwhile, the House must be vigilant about passing such a far-reaching Bill.

The operation which the Bill seeks to provide free under the National Health Service is accepted by the proponents of the Bill as being irreversible. Even without the operation being provided under the National Health Service, the number of operations will increase. Once the operation has the blessing of the National Health Service, with the Minister sending out circulars about it, the numbers will rocket. The hon. Member for Derby, North has been frank throughout the proceedings and he has told us of the waiting lists for this operation. We have no assurance that the people who are advised to have the operation will know exactly what they are doing.

The new Clause is essential because of the consideration which will be brought into this whole subject following the effects of any further research, and particularly the effect upon people's minds. Let us take the case of a man who has the operation at the age of 30 or 25, or even at the age of 21 since it must be remembered that there is no age limit. If a husband and wife are having marital difficulties, it may well happen that a busy family doctor may not spend a great deal of time on the case personally but will send the couple to a local family planning clinic for advice. What will happen when the young man goes to that clinic for advice?

12 noon.

Mr. Phillip Whitehead (Derby, North)

What has this to do with the new Clause?

Mr. Fell

This argument is essential to the new Clause, because I want to avoid the possibility of this provision being misused and things going wrong.

To come back to the case of the young man, if his marriage is in difficulties he may well be easily persuaded by a stronger personality than his own to follow a certain course of action. The counsellor may well say to the wife "It seems to me that the main cause of your marital troubles has to do with your sexual relationships. There is a way in which you can get out of those difficulties. You will not have to worry about becoming pregnant because of your husband's attentions." I agree that this would have to be carried out on a doctor's advice, but the doctor concerned might be thoroughly in favour of a vasectomy operation.

Let us follow up the case of the young man who has this irreversible operation. Let us suppose that his wife is involved in a terrible tragedy and is killed in a motor crash on the M1. If the young man later meets another girl and wishes to marry her, he will have to tell her "You must remember that you will not be able to have a child by me." This is one of the serious considerations which enter into discussion of the Bill, namely, the whole subject of safeguards.

The hon. Member for Pont pool (Mr. Abse) made many discourses in Committee on the need for careful advice to people who attend clinics, but I query at once the whole basis in which all responsibilities for an individual's actions are taken over by the State. The State involves itself in everything, and nothing will be left to the individual. Is it too much of an exaggeration to say that if things go on as they are, with everything coming under the State umbrella, there will come a time when people will be in capable of accepting any responsibility for themselves? Will not the National Health Service be butting in and sending circulars to local authorities telling them what to do and issuing plans for birth control throughout the country: "Vasectomise the nation"?

A Liberal member of the Standing Committee made a serious contribution to our debates. I will not go in detail into what he said, but it shows the danger of not having full parliamentary control in a matter such as this. I am sure that my hon. Friend the Under-Secretary of State will say that we do not have to worry because the National Health Service will be reorganised in 1974. So what? What assurance does that give us that when this Bill becomes an Act it will not simply be taken under the wing of the National Health Service and then be pushed by the whole panoply of that service as a way to exercise national birth control?

Mr. Lipton

The whole force of the hon. Gentleman's argument is directed to the fact that he does not want the National Health Service to have anything to do with this operation, or to have only a limited capacity to deal with it. Does he not appreciate that at present anybody who is prepared to spend £30, £40 or £50 may have the operation?

Mr. Fell

The hon. Gentleman is right. There was a ruling about 10 years ago—I do not know the exact date—by Lord Denning on this matter. The hon. Gentleman is right to say that for £30 or so one can have the operation. I believe that Lord Denning still regards the operation as illegal, except for medical reasons.

Mr. Biggs-Davison

My hon. Friend wished to know the date of that judgment. It was in 1954.

Mr. Fell

I am grateful to my hon. Friend for supplying the date, 1954, which was quite a long time ago. I was about to give another illustration of how serious this whole matter can become and how important it is that this new Clause should be accepted to limit the disasters which might accrue from the Bill's provisions and to provide that the matter shall be examined every year.

I should like to draw to the attention of hon. Members some remarks that were made in Committee by the hon. Member for Cornwall, North (Mr. Pardoe). I am sorry he is not present because I am sure he would soon be interrupting me with a cry of "Rubbish", but I will put to the House the burden of his argument. It was an argument that made the hair of several hon. Members—not only opponents of the Bill—stand on end. In a way, the hon. Member's argument was quite fun. He said: I was trying not to take up more time of the Committee than was absolutely necessary. May I slow down for the sake of the calculations to come, merely taking three items which are fairly easily quantifiable and which I have, in fact, already quantified."—[OFFICIAL REPORT, Standing Committee C. 23rd February, 1972; c. 174.] What the hon. Gentleman was doing was quantifying the amounts that would be saved for every man who was vasectomised and for every child prevented from being born. If that is taken to its logical conclusion, it will be seen that it might be possible to do away with the National Health Service within a few years, since no one would be born—

Mr. Speaker

Order. I have given the hon. Gentleman a great deal of latitude in making what is really a Second Reading speech. I ask him now to come a little closer to the new Clause.

Mr. Fell

I am most grateful to you, Mr. Speaker, for bringing me more to the point at issue, and of course I shall respect what you say. Nevertheless, I am sure you will not be too angry with me if from time to time I use illustrations to show how dangerous it would be for the nation—

Mr. Speaker

Order. I am never angry with the hon. Gentleman, whatever he may say.

Mr. Fell

I am even more grateful for that, Mr. Speaker. That assures my future at least. Though I may be told to sit down, I shall be told with a smile, which is always nice—[HON. MEMBERS: "Sit down."] There was a time when I was about to be interrupted by the most senior Member of the House. I did not permit him to do so, and Mr. Speaker made him sit down. Now, four or five hon. Members opposite are trying to usurp your position, Mr. Speaker, by telling me to sit down. They cannot do it. With the exception of myself, by the application of a certain amount of self-restraint, the only person in the Chamber who can tell me to sit down is you, Mr. Speaker—

Mr. Speaker

Order. There is nothing in the new Clause about the hon. Gentleman sitting down.

Mr. Fell

I stand corrected, Mr. Speaker. You are absolutely right.

Perhaps I might complete my illustration. This must be germane to the subject. The importance of the Bill is enormous. It should never have been a Private Member's Bill, though it was brave of the hon. Member for Derby, North to introduce it and try to get it through. Its importance is enormous because we are discussing the lives of tens of thousands if not millions, of yet unborn children. Depending on how tough a future Government become with their birth control policy, we are talking about the future of tens of thousands, perhaps millions, of young men who may be advised to be vasectomised by Government-sponsored busybodies. That is the importance of the Bill if it should become an Act.

I shall complete the quotation from the speech of the hon. Member for Cornwall, North. He was showing how much money could be saved by the State. It would be unfair to the hon. Gentleman to quote only part of his speech and not to quote the actual figures that he used. He said: First family allowances. These are the savings that he forecast. Taking the figure of 10,000 on the waiting list and assuming that each vasectomy means one less child, though in fact each vasectomy will mean rather more than that, that is 10,000 fewer children. Let us assume that those children are not the first children, that being the likely event—most vasectomies will be after a certain number of children have already arrived"— because most vasectomies would not be advised, I hope, until someone had had more than one child and probably more than two— that works out roughly at £10,000 per week or £500,000 a year. That is in respect of those 10,000 children who will not be born because of vasectomy operations.

12.15 p.m.

The hon. Member for Cornwall, North went on to say: Next, the savings in tax allowances. The tax allowance for a child under 11 works out to the parent at about £50"— it is different since the Budget— so that would save £500,000 a year. The cost of a primary school place is about £100. It was £102 last year. So that is £1 million. There is a cool £2 million on three items alone saved for a cost of £200,000, and, as a taxpayer, I rate that a very good bargain."—[OFFICIAL REPORT, Standing Committee C, 23rd February, 1972; c. 174.] The hon. Member for Cornwall, North was saying that for £200,000 we can make sure that 10,000 children are not born, which would save the State at least £2 million on three items that those children would later have cost the nation.

If you say to me, Mr. Speaker, that I have taken up enough of the time of the House on my humble contribution, I shall not dispute it—

Mr. Speaker

Order. The hon. Gentleman has issued an invitation. I accept it. Will he now bring his remarks to a conclusion?

Mr. Fell

I am grateful for your prompt attention to my wish, Mr Speaker. It is with the greatest pleasure and confidence that I shall have the support of other hon. Members that I commend the new Clause to the House.

12.15 p.m.

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

I rise, I hope not causing any offence to any hon. Member in any part of the House, to make an early intervention on what is an important new Clause. I hope that in so doing I shall not in any way evade my opportunity or responsibility for listening carefully to any further speeches. I thought that it might be to the advantage of the House if I commented in detail at an early stage on the point which has been made about circulars of guidance—

Mr. T. G. D. Galbraith (Glasgow, Hillhead)

Is my hon. Friend about to give us the Government's advice on circulars generally, and then allow other hon. Members to comment on what he has said? If that is the case, will my hon. Friend feel precluded from commenting on anything said in subsequent speeches? This is one danger of a Minister intervening so early in a debate on what is quite an important new Clause.

Mr. Alison

I must play this one by both ear and eye. I think that the major responsibility for commenting will rest upon the hon. Member for Derby, North (Mr. Whitehead). But I shall remain at the disposal of the House, and I shall intervene if hon. Members should ask specific questions.

I must begin by addressing myself to the precise terms of the ingenious but unsatisfactory new Clause. It is ingenious because it seeks to effect a peculiar hybrid marriage. But it is unsatisfactory because such marriages often fail to realise the full benefits of more orthodox conjunctions.

What my hon. Friend the Member for Yarmouth (Mr. Fell) has sought to do is to impart to a circular issued by the central Department to local authorities the full status of law. I am afraid that I must advise the House that this would be an unsatisfactory imposition for the Government to accept in terms of this Clause. The House will be aware that the Bill, which was given a Second Reading without a Division, made provision to empower local authorities to perform certain functions. In that case, if it is the wish of the House that local authorities should so be empowered any guidance which is proper in this context must be guidance which cannot be held to be legally binding.

If the new Clause is accepted it will impose upon the central Government the peculiar task of making circulars to local authorities, which are semi-independent bodies, have the full force of law. If the House wishes to legislate in respect of local authorities, the specific powers which they may or may not have and the specific duties which they may or may not perform by law, then it must produce the law. It must either produce firm proposals or give delegated powers to make regulations which the House can in turn consider under the normal Statutory Instruments procedure.

If the House has decided to empower local authorities to perform certain functions, it is not acceptable in the same breath to seek to inhibit, restrict and limit those powers by circulars. Normally, circulars, as understood in local authority matters, cannot have the power of law; they are for guidance. I must on those grounds suggest that this is an improper constitutional and legislative development which the House should reject.

At the same time, I am grateful to my hon. Friend the Member for Yarmouth for bringing forward this ingenious new Clause and giving me the opportunity to go over some of the ground which I promised in Committee to go over concerning guidance. I refer specifically to the accepted kind of guidance which does not have the force of legally binding obligations upon local authorities, but is the kind of guidance which local authorities are accustomed to receiving and for which they normally look.

Mr. Leo Abse (Pontypool)

Although I fully appreciate the Minister's point about the legal enforceability of the circulars, may I ask whether I am right in saying that under the parent Act it is open to the Government or the Minister to approve or not approve any schemes into which local authorities may enter? Am I not equally right in presuming that if the guidance is being disregarded it is open to the Minister not to approve grants or assistance to any such local authority?

Mr. Alison

That is true. Any provisions made under the parent Act, which the House has therefore agreed to accept, are binding upon any matter if it should arise under this extension of the Act. I am making the narrow point that it would be improper to seek to treat the kind of circular which I am about to discuss as having the full force of law.

I warned the Committee, and I must now warn the House, that it would be impossible for me to give a specific advance view or trailer of the precise terms of any local government circular which we may issue in future in the context of the Bill. We must see whether the Bill is finally passed. It will be against the background of the debates which we have had, not only in Committee, but in the House, that we shall wish to consider the precise terms of the guidance.

For the convenience of the House I will now summarise the main headings which in general terms we would seek to cover in the circulars which we shall issue in connection with the Bill. I refer back to the commitments and views which I expressed when we debated this subject in Committee.

I expressed the view in Committee—this will be reflected in the circular—first, that vasectomy should normally be regarded as an operation only for married men or, by way of variation on that, men who enjoy a stable union and have completed their families. This will be the main framework of guidance, the main guiding rule, which we shall seek to set forth in the circular. It will be the guiding rule against which any exceptions should be placed in their proper perspective.

Mr. Fell

My hon. Friend has already got himself into the most hopeless trouble. He has just said that the main guiding rule will have it in a reference to the person—it has to be a male; we all know that—and that he has to have completed his family. What kind of suggestion is that? Who knows when a man or woman has completed his or her family? There are thousands of cases in which a man and wife think that they have completed their family and then have another child, probably by accident, five or 10 years later. And who is to say that that is not the best and happiest child of the lot?

Mr. Alison

I shall hope to cover my hon. Friend's misgivings as I develop the broad framework of guidance which we hope to give. Since he drew particular attention to the word "rule", which I perhaps inadvisedly used—I carefully put it in inverted commas in my notes because I said that the circular cannot have the force of law—I repeat that, within the main framework and guidance which we shall seek to give, we hope to draw to the attention of local authorities our belief that the law should be the limitation of sponsorship for this operation to married men or those enjoying a stable union and that such men should have completed their families. I assure my hon. Friend that I shall hope to deal with the term of art which he suggests is involved in that phrase.

Secondly, I indicated in Committee, and I undertake that it will be given expression in the circular to local authorities, that we would expect them to give particularly careful consideration to any proposal to carry out the operation on men who were younger than the general rule of patients for whom such an operation might be indicated.

Thirdly, I said in Committee—and I repeat that this will find reflection in the circular—that the consent of the wife should normally be obtained in every case.

Those three main points form the outline bulk of the general import of the guidance which we shall seek to elaborate to local authorities.

I turn now to counselling, an aspect of the whole question of vasectomy which perhaps engaged to the greatest extent the concern and interest of the Committee when debating the Bill. The Government have given a good deal of careful thought to the question of counselling as a result of both the points made by the hon. Member for Pontypool (Mr. Abse) and others in Committee and points which have been made since.

This is an area in which the Government are bound to steer a careful course. If we want to give positive advice about counselling we must remember the realities of the Government's position. The Bill explicitly seeks to confer powers on local authorities which are answerable to their own electorates. They enjoy a real measure of independence; they are not simply the agents of Whitehall. Indeed, the whole purpose of the Local Government Bill would be frustrated if in this context we sought to narrow rather than to develop the area of discretion and responsibility which local authorities already enjoy.

The House will appreciate that the danger of being grandmotherly towards local authorities is real. It is probably true that the best way to induce responsible behaviour in local authorities is to assume in them the responsibility and trustworthiness which already exist and not to treat them as needing to be bossed, badgered and prompted at every turn.

At the same time, in the matter of counselling we are straying into the area of professional training and knowledge where the judgment of an individual doctor, for example, is a real factor. A reference to the importance of counselling in general terms is a perfectly proper and valuable provision for the Government to make, but a detailed specification of the precise form that counselling should take would probably be counter-productive because there is such an infinite variety of individual cases which we would have to seek to specify. For these reasons, we believe that it is not practicable to give, in the administrative circular, the sort of range and degree of advice which some hon. Members in Committee have been hoping for.

12.30 p.m.

Mr. Fell

My hon. Friend is showing the same courtesy and kindness which he showed throughout the earlier stages of the Bill, and I thank him for giving way again. He has said that of course he does not want to go too much in the way of direction to local authorities, but that they have to have guidance and help and so on, which is the purpose of circulars. Do I understand him to say also that these powers will remain with the local authorities after the reorganisation of the National Health Service?

Mr. Alison

No. There is no question of that. What we are discussing here is the circular of guidance which arises under the Act and not the Bill, which lapses upon the loss by local authorities of their health functions following the introduction of the Bill to reorganise the National Health Service, which, whenever the Bill is introduced, will take place in 1974. We are thus talking here about a circular which will have effect only so long as the local authorities remain local health authorities. A terminal date is set upon it. I hope that puts my hon. Friend's mind at rest.

Against this background of having to tread delicately and not only registering confidence in local authorities, which I believe is fitting, but of having to recognise also that professional matters arise in the question of counselling, the Government have decided that an administrative circular would not be the proper vehicle for going into details on counselling. I am happy, therefore, to announce that the Chief Medical Officer in my Department is to set up a group of persons with special interest and knowledge of this subject which will help him prepare advice, for transmitting on what I might call the professional network, to medical officers of health about counselling. This advice will be transmitted on the professional network to medical officers of health at the same time as the administrative circular is sent out, and the circular itself will make allusion to it. But it will be distinct and definitely directed, because of the professional implications of counselling, to the professional people involved in local health authorities.

Through the courtesy of the hon. Member for Pontypool, I have had sight of an expression of views presented to him by the British Medical Association and the Medical Defence Union bearing upon the local authority implications of the extension that the Bill implies. The B.M.A. in particular feels, I believe, that it is essential that the operation should be carried out under full sterile conditions in an operating theatre of a hospital, nursing home or group or health centre. The M.D.U. is particularly concerned at some of the failures which have occurred in the operation, viewed in the aftermath, and I understand that these failures may have been due to faulty follow-up.

First, I will deal with the M.D.U. case. We believe that the range of counselling which the Chief Medical Officer's committee will consider and transmit to the professional bodies concerned will lay some special stress upon the vital importance of follow-up, which is really the key to avoiding the failures about which the M.D.U. has had some misgivings.

On the case put by the B.M.A., I remind the House that the Family Planning Association already requires the following facilities before opening vasectomy clinics—an operating theatre, facilities for sterilising equipment, a consulting room for the surgeon and the Association doctor, changing cubicles and toilets, a re- covery room for beds, and a room for the reception clerk and health workers. Many local authorities will wish to make use of the Association as agent, in any case, and I find it inconceivable that any local authority which does not do so would seek to provide the facilities needed for this work on a scale less demanding or less exactly than the standards imposed by the Association.

The administrative circular should, first of all, lay stress upon the need for the local authorities to limit the sponsorship of this operation to married men or those with a stable union and those who have completed their families; secondly, it should quite explicitly state that the consent of the wife should normally be obtained; thirdly, particularly careful consideration should be given to any proposal to carry out the operation on men who are younger than the general rule of those for whom the operation might be indicated. I add, further to that, that there should be, alongside the administrative circular, advice on the professional network, and I hope I have made clear that the B.M.A. and M.D.U. sensitivities and concern will be fully borne in mind.

I believe that the view of my hon. Friend the Member for Yarmouth as to exactly when it might be held that a family has been completed is exactly the sort of thing where sensitive counselling alone can provide proper safeguards. It is impossible, as it is already impossible in the provisions of the National Health Service, to lay down hard and fast rules, and it is in this area that we look to counselling to provide proper safeguards.

Mr. Galbraith

I understood my hon. Friend to say that account would be taken of the general age, but I did not quite catch the point. Could he elaborate? What does he mean? If the average age turns out to be 50, will the operation tend to be done at that sort of age? What is the point of the reference to average age?

Mr. Alison

We have sought deliberately to avoid any reference to a particular age, because otherwise there would certainly be anomalies. By making a broad rule, I have sought to set down one in which the operation should be considered as suitable only for married men who have completed their families, and in this way we are already narrowing the range or normal applications for the operation to a certain age group. It is by reference to this age group that those who are younger than that will be subject to consideration and counselling.

Mr. Fell

My hon. Friend, in referring to the point I had raised, said that the sort of thing such as deciding whether a family is completed or not depends upon sensitive counselling. Have we really got to such an idea that we can tell a man and woman who have got a family better than they can tell themselves whether their family is completed? This is the whole nonsense of the case.

Mr. Alison

That is not the case. There is already within the law of the land and in the operation of the National Health Service complete freedom for individuals to decide for themselves whether to have this operation. All I am saying is that establishing also whether or not in a particular case it really is in the best interests of the individual concerned to have this operation is best left to sensitive counselling and is certainly not a matter for statutory limitation or law.

Mr. John Stokes (Oldbury and Halesowen)

I came to the House today because I feel so deeply about the dangers of the Bill. I was therefore sorry to hear my hon. Friend—for the first time, to my knowledge—give the Government's wholehearted and complete support for the Bill so early. That is a change in their original attitude. Everything that the Minister has said so far has strengthened my determination to resist this wholly unwarranted interference by the State in what is essentially a private matter. This is not an area in which the State should interfere at all. The idea of State counselling terrifies me. It is wrong that public money should be expended on these matters. Where will it all end? Eventually, it will end up like Russia.

Mr. Alison

I must try to adjust my hon. Friend's perspective slightly. He must try to understand that the Government have faced the fact that the House gave a Second Reading to this Bill without compulsion or constraint by the official Whips. That is the perspective in which we have to work. The Govern- ment's interest is to secure that, for the very short period for which the Bill will apply, all the proper safeguards and provisions which may be necessary and reasonable will apply for the health of individuals who will henceforth be able to secure this operation under the National Health Service, in addition to already being able to secure it privately. So when it comes in under local government we want to ensure that the same reasonable and humane conditions apply.

My hon. Friend talked about counselling. He will appreciate that there is already State counselling, although the term is odious and misleading. In so far as the general medical service provided under the National Health Service, in the shape of the work of the general practitioner, is State-subsidised and fully State-supported, it is an integral and essential part of the work of a general practitioner that at every stage in his professional relationship with a patient he should be counselling him or her on personal issues affecting the patient's health.

We seek now to do no more than ensure that counselling which is right and proper for operations with profound medical implications should be as effective when it is provided under local government auspices.

Several Hon. Members rose—

Mr. Alison

Perhaps it would be more appropriate if I did not give way any more now but listened to my hon. Friends' speeches and any comments which they have to make.

Mr. Biggs-Davison

I am grateful for the clear and concise way in which my hon. Friend the Member for Yarmouth (Mr. Fell) moved the Second Reading of the new Clause. I apologise to the House for having been absent for a few moments as a result of the very serious statement which my right hon. Friend the Prime Minister made before the debate.

The Under-Secretary at least paid a tribute to the new Clause when he described it as ingenious. My hon. Friend and I are grateful for that much. After that faint praise, he proceeded to damn the new Clause by saying that it was unsatisfactory and that it was not appropriate to give the status of law to a circular of the kind in question. I should have thought that, in this very important and far-reaching matter, a circular might have been designed in the same way as the code of conduct which accompanies the Industrial Relations Act.

It seems to us that control not only by the Secretary of State but also by this House is important. That is why we ask in the new Clause that any such circular should be laid before Parliament. Normally we are not acquainted with the terms of circulars issued by the Secretary of State on these matters.

The Under-Secretary said that he could not give the precise terms of the circular which he had in mind, but he was good enough to suggest certain conditions which he thought should be imposed upon vasectomies under the Bill. We are grateful for this. He said that this operation should be only for men but also only for married men, for those who enjoyed a stable union and who had completed their families. There was some discussion about this. This is one of the vaguenesses which require consideration. My hon. Friend the Member for Yarmouth waxed eloquent about it.

12.45 p.m.

I can contribute something from my personal experience. In my own family there is a gap of seven years between our last child and our last but one. It was not our intention that our youngest daughter should be born. My wife and I do not approve of artificial means of contraception. Let us suppose, however, that we had taken a different view and that after the birth of our fifth child—we have six—we had seriously considered whether or not we had completed our family and had resorted to counselling, the sensitive counselling which my hon. Friend is concerned should exist. I am sure that, even without sensitive counselling, we should have concluded at that stage that we had completed our family. But we are now fully aware that that would have been a wrong decision.

This is very difficult. It is not enough to say that, after a bit of serious thought and after seeing a good counsellor, one can come to the right conclusion. In many cases I do not believe that one will come to the right conclusion.

One way out of this was to raise the age limit from 30 in the original Bill to 60. This was the purpose of the Amendment in the name of my hon. Friend and myself. In the end, however, no age limit was written into the Bill. This is one of the serious reasons why we are concerned about the form and content of any circular issued by the Secretary of State to the local health authorities.

The new Clause reaches to the whole question of parliamentary control. After all, the hon. Member for Derby, North (Mr. Whitehead) seemed to sympathise with our point of view because he said when moving the Second Reading: '"The Bill is a short one…but I would not seek to disguise from the House the fact that it touches upon great issues—issues of human relationships, parenthood and family life."—[OFFICIAL REPORT, 21st January, 1972; Vol. 829, c. 826.] We cannot take this matter as lightly as some hon. Members would wish. At least the hon. Member has been frank with the House, as has my hon. Friend the Member for Norwich, South (Dr. Stuttaford), who was the only medical Member on the Standing Committee—

Mr. Fell

And the hon. Member for Halifax (Dr. Summerskill).

Mr. Biggs-Davison

At least, my hon. Friend was one of only two medical Members on the Standing Committee. He was very blunt about it and said we must assume that the operation is irreversible. That also is the position of the hon. Member for Derby, North. The new Clause would ensure that so drastic and irrevocable an operation should not be carried out without strict control—and much stricter control than is provided for as the Bill has come from the Standing Committee.

The Standing Committee was of the view that the Secretary of State should be kept fully informed. An Amendment was unanimously supported to enable the right hon. Gentleman to receive annual reports from all local health authorities. We are here concerned to see that Parliament is kept fully informed and has some control in the matter.

The Minister spoke of the sort of criteria that his right hon. Friend will wish to lay down. Alas, he will not always be in office. We do not know what regulations will be introduced and we want a degree of certainty by ensuring that they are laid before Parliament.

The hon. Member for Pontypool (Mr. Abse) laid great stress on the need for counselling. On Second Reading he said that there could never be a completely watertight system of counselling. He tabled an Amendment in Committee to require psychiatric advice to would-be vasectomees and asked that, alternatively, advice should be given by a counselling service. Unfortunately the Standing Committee rejected that Amendment. Despite what the Minister said, we are left in considerable doubt that adequate counselling will be given. Perhaps the hon. Member for Pontypool was satisfied with the Minister's remarks, and we look forward to hearing his point of view because he rightly laid stress in Committee on the importance of adequate counselling.

When the Bill was originally presented to Parliament it stated that vasectomy should not be performed on a man aged less than 30. Indeed, the hon. Member for Derby, North said on Second Reading: For the couple who present themselves, calmly and rationally, for vasectomy but with no medical indication that it is needed, the only additional check required would be a lower age limit for the man, which the Bill fixes at 30. By that time society can say it has protected for a long period a man's right to have a family"— I am glad that the hon. Gentleman believes in that— even though he wishes to abdicate that right. He continued: In the vast majority of vasectomies done outside cases of extreme medical need the man is already 30 or considerably more".—[Official Report, 21st January, 1972; Vol. 829, c. 837.] That is doubtless the case. Nevertheless, such is the pressure from what I call anti-life propaganda and the pessimism in some leading circles about the future of the human race that I am not sure that it would always be the case that a man presenting himself for vasectomy would already be 30 or considerably more.

There are impressionable people, and all the propaganda nowadays is towards every form of contraception and abortion. There are the masochists, to whom the hon. Member for Pontypool referred eloquently. If there were no statutory age limit the situation would be extremely serious because men under that age—immature and irresponsible men; this would be the case despite what might be in the general principles laid down by the Minister—would find some, if not many, medical men who would be willing to perform this irreversible operation, as we are informed we must regard it.

Mr. Galbraith

Would not my hon. Friend agree that the younger a person is, the greater will be the pressure on him to ask for an operation which later, when he becomes more responsible, he may deeply regret?

Mr. Biggs-Davison

I am obliged to my hon. Friend for putting the point so succinctly.

I referred to this matter in Committee when I said that younger people were today less susceptible to the advice of their elders and established society while being more susceptible to fashion, and fashion today is all on the side of this sort of thing. This is the trend.

We must, therefore, protect younger people from decisions which they may subsequently regret. We are dealing not with normal contraception or abortion, because a woman can bear children after an abortion.

Mr. Fell

Not always.

Mr. Biggs-Davison

That is correct. This is an irrevocable and irreversible operation and we want to be sure that younger people are protected.

In Committee the right hon. Member for Sowerby (Mr. Houghton) often descended upon our deliberations at about noonday—I do not see him among us today—and then, rather like a non-vasectomised bull in a china shop, upset the apple-cart. I say this with deep respect to such a senior Member. On one occasion, to the horror of the sponsor of the Bill, the right hon. Gentleman succeeded in deleting the age limit of 30 from the Bill.

Mr. Fell

He vasectomised the Bill.

Mr. Biggs-Davison

For once we had the sponsor voting with us. It was clear from the remarks of the hon. Member for Pontypool that that action changed the complexion of the Measure.

We owe it to the House at this stage, and particularly to some of our colleagues who have entered the debate for the first time, to point out that this is not the Bill which received a Second Reading without a Division. This Measure provides for vasectomy on the rates at any age, subject to what local authorities, doctors and the Department may want to happen.

That is one reason for the new Clause. We do not desire simply the general aspirations of the Department to be made known. We want put down in black and white what are the restrictions under which this operation may be carried out within the family planning system. We ought to hear a little more from my hon. Friend the Under-Secretary about this. It is not enough for him to say "Here are the sort of conditions I should like to see." We must have laid before us the sort of circular that will go out. We must know what is in it and be satisfied, so far as we can be—those of us who are opposed to it in principle cannot be satisfied, but the House as a whole ought to be satisfied—that if there is to be this extension of vasectomy at public expense through local health authorities, the circumstances in which the operation may be carried out are known and properly circumscribed.

1.0 p.m.

Dr. Shirley Summerskill (Halifax)

First, speaking from a neutral Front Bench, I give my personal views on the Under-Secretary's statement. I can agree with his general reflections on the new Clause and would oppose it. It seems a contradiction in terms to have statutory guidance. By its very nature, guidance cannot be statutory and cannot be imposed on local authorities.

We heard in Committee and today once more the vitally important guidance which will be given to local authorities. We now have the guidance that older men rather than younger men will be receiving this operation; that they will be married rather than single men and that they will have families rather than no families. All these are important and necessary assurances. It would be wrong to lay down in a Statute guidance for what is, after all, a surgical operation. In this operation, many factors will be taken into account, and not only the age of the person, which in itself is vitally important. But it would be difficult to lay down a magic age above which the operation can be performed and below which it cannot and to say that it should be 30 rather than 40 or rather than 35. That would make the operation extremely difficult to carry out.

Not only age but the social and economic background of both the man and his wife would be considered. The reasons why they want the operation are very important. The general health of not only the man but, more important, the woman, the number of children, whether they are alive and their ages, and the emotional stability of the couple and the marriage must be taken into account by the family doctor, the surgeon who is undertaking the operation and the counsellors.

This is, therefore, a very complex subject. It is the carrying out of what has been regarded by the Committee and the House as an irreversible operation. Therefore, all these factors have to be considered carefully, and we must have some trust in the doctors, the G.P. and the surgeon, and those who will be counselling the man involved. It would make their job extremely difficult if not impossible to lay down in a Statute certain conditions for the operation. Every case will be different and will have different factors. There will always be some cases where regrets will be felt afterwards. That is inevitable. It is possibly inevitable in any operation but more so in this one.

I welcome the statement about the setting up of the chief medical officer's special committee, which will serve to give guidance to the counsellors. Therefore, they in their turn will feel that they have a body to which they can go for advice.

We have heard a great deal from the supporters of the new Clause about State intervention. They have been opposing State intervention, yet by the Clause they are advocating more State intervention concerning this operation. On the one hand they are saying that the individual should be free to make decisions for himself—which we fully support—but on the other hand they are saying that the State can intervene.

The Bill has a completely voluntary aspect all the way through. No one is being forced to have this operation. As I pointed out on Second Reading, the Family Planning Association is very careful to counsel man and wife and to give them an interim thinking and deciding period before the operation to make quite sure that they really want it. The voluntary aspect is further emphasised by the fact that rigid stipulations will not be laid down.

Each case will be considered separately and there is freedom for the individual to consider this method of family planning. After all, if we deprive individuals of this method—which is a legal operation already being carried out in the private sector of medicine for people who want it and are able and willing to pay for it—we are therefore limiting the available methods of family planning for those who cannot perhaps afford to pay for this in the private sector. We are simply adding a last-resort method of family planning to the methods already available.

Mr. Fell

Does not the right hon. Lady agree that there is an extraordinary difference between being able to pay for the operation and having the operation with the whole panoply of the State?

Mr. Deputy Speaker (Mr. E. L. Mallalieu)

Order. The hon. Gentleman is now going to the principle of the Bill.

Mr. Fell

I apologise, Mr. Deputy Speaker. I was asking the right hon. Lady what I thought was a question directly related to what she had been saying.

Mr. Deputy Speaker

The hon. Gentleman must not follow the hon. Lady in the direction in which she was going—unfortunately, not pulled up by the Chair.

Mr. Galbraith

Surely that is something we always do to Eve.

Dr. Summerskill

The hon. Lady will not stray from the path any longer; anyway, she was about to conclude her remarks.

The proposals put to the House by the Under-Secretary seem a more acceptable way of looking at the Bill than the rigid rules which would be imposed if there were statutory guidelines—not that it is possible in practice to have guidelines which are, at the same time, statutory.

Mr. Galbraith

I support the new Clause which my hon. Friend the Member for Yarmouth (Mr. Fell) moved very clearly and in a way that was helpful to those of us who did not have the opportunity to serve on the Committee.

It seems to me that the purpose of the Clause is that the Secretary of State should not circularise local authorities in secret but that the circulars should be the subject of regulations laid before Parliament. This may seem an unusual thing to do, but, after all, it is rather an unusual operation.

Such a procedure would fulfil two useful functions. First, it would enable those of us with doubts or worries about the developments to air them. That is one of the most important functions of Parliament. It is a forum where we can do that. Second, and very important, as a result of the debate here the public may be made aware of the various doubts of some of their representatives and the dangers they see.

Therefore, it would be helpful to have an assurance from the hon. Member for Derby, North (Mr. Whitehead), whose Bill it is. I refer to him because my hon. Friend the Minister has withdrawn and has had nothing to do with the matter, though I believe the opposition to the Clause comes from him on rather purist, constitutional lines. I have been in the same sort of position as my hon. Friend, though not in the English sense but in the Scottish sense, and the Scots take a very strict constitutional view of things. I do not know that that is necessarily right. My hon. Friend was saying that we must either leave things to the local authorities or do them ourselves. Both sides of the House have a kind of love-hate relationship with local authorities. When local authorities are doing what the party in power agrees with, they must have every freedom. When they wish to do something the party in power does not agree with, they should not have any freedom at all. At this moment a Bill is going through the House to restrict the freedom of local authorities in relation to house rents. I do not know that my hon. Friend failed to support the Government on that. Therefore, I regret the rather purist line that he is taking. I conditions in the circulars to be tabled believe that it would be possible for the and either approved or not approved by the House.

The Minister's remarks were very interesting. He made them with great clarity, but, like my hon. Friend the Member for Oldbury and Halesowen (Mr. Stokes) I was rather startled by some of the things he said. Perhaps if he had not been such a good Minister and had not been so clear I should have gone for my lunch instead of having my stomach rumbling just now. But I felt I had to say one or two things because I was concerned by his statement, particularly in connection with the advice that the operation should be carried out only on married men.

I understand that it is purely advice, and that there is no compulsion about it. The local authorities can ignore the circular altogether. We know how, when people have a bit between their teeth, they pay little or no attention to advice. I thought my hon. Friend's statement that the operation should be carried out only on married men was a good point, but he qualified it by saying, "when they have completed their family". I do not see how one can tell when they have completed their family. We have the evidence of my hon. Friend the Member for Chigwell (Mr. Biggs-Davison) that people get married very young nowadays. We all know that. They are getting married younger and younger. The tendency is to have one or two children.

1.15 p.m.

A man of 28, who could easily be the father of four children, urged perhaps by his wife, his social conscience or all the trendy things we read about in the newspapers these days, and encouraged by the fact that the operation is easily available under the National Health Service, may go along to the sensitive counsellors. Incidentally, I do not see how anyone could be a counsellor unless he or she was sensitive. When he explains that he wants the operation, that he has four children and is aged 28, they say, "Why not?" Then a year or two passes and a disaster happens. His wife may be killed and there may be a breakdown in the marriage. Plenty of people do not event start having a family until they are over 40.I speak from personal experience. I did not get married until I was 39. Suppose I had been roving around the world as a sailor, which indeed I had, and had had the operation—though I admit that one could not if one's local authority followed my hon. Friends advice. But I think the conception of having completed the family is nonsensical. I do not see at what age it is possible to say that one has completed one's family. That is one reason why I am very worried about what will happen. I do not think my hon. Friend said what would happen after the reorganisation of the National Health Service, but if he could say a few words on that, it would be helpful to the House.

I must refer next to the hon. Lady who led us astray, the hon. Member for Halifax (Dr. Summerskill). I understood completely why my hon. Friend the Member for Yarmouth referred to her as "the right hon. Lady". It was the most natural mistake. I had only to shut my eyes for a moment and to me it was her noble mother who was speaking.

Mr. Fell

I must plead guilty to describing the hon. Lady incorrectly not once but four or five times. I am extremely glad she corrected me in the end.

Mr. Galbraith

I remember that in the old days—and when I speak about the old days my children, who are very young, ask what I mean, and I say "Fourteen or fifteen years ago", when they were not alive—the hon. Lady's noble mother was sitting on the bench that she herself has been sitting on today and I was sitting on the bench that my hon. Friend the Minister is now occupying. I had only to close my eyes for a moment and I had the feeling I was listening to her noble mother again.

The hon. Lady spoke very effectively. I am sorry she has gone, because I wished to ask her whether in the course of her professional life she had had any experience of the effects of the operation. I thought she was perhaps just a little unkind when she said to my hon. Friends and myself that we were asking for extra State intervention. Is not this always the trouble? Once the devil—in this case the State—is let in, we do not get a little devil. There is a natural tendency to see more: "Quis custodiet custodes ipsos?".

I hope that is understandable to the House, even in these days when the classical languages are not as well known as they used to be.

I hope that for the few reasons I have given it may be possible for the hon. Member for Derby, North to see that there are some matters concerning us and to indicate that he does not necessarily take the view of the Government Front Bench.

Mr. Abse

My approach to this new Clause is to ask myself whether it is likely, if accepted, to assist the stabilisation of family life. We are all exceedingly grateful to the hon. Member for Yarmouth (Mr. Fell) and the hon. Member for Chigwell (Mr. Biggs-Davison) for having tabled the new Clause. It has given the Under-Secretary the opportunity of making his statement and has given us the opportunity of discussing whether we are likely to make a contribution to the proper use of family planning and, hence, the enchancement of family happiness.

The appoach of the hon. Members for Chigwell and Yarmouth and my approach are quite different because, as they have frankly indicated, they are opposed to all forms of contraceptives and, impliedly, to these forms of family planning. There is a great difference between us, and, therefore, there will be a difference in our approach. Although I have valued, in Committee and on the Floor of the House, the contributions made by the hon. Members, I regard it as my duty to point out that we live in a plural society in which if we hold particular views, however tenaciously, with whatever regard and respect, there comes a time when, having contributed those views, it is time to accept the consensus.

My second approach to the new Clause is as to assessment—whether it is likely to contain the proliferation of vasectomy so that its use will be generally a proper one or whether it is more likely that there will be abuse. Clearly, whether or not the hon. Members who framed the new Clause like it, vasectomy is here and it will be part of the family planning armoury. It is legal and available cheaply. It can either be done under proper circumstances, with sensitive advice and guidance, or it can be done merely by the payment of fees to any irresponsible or psychopathic doctor. I would have thought that both hon. Members would have been concerned, particularly since they share with me a hostility towards the abortion Act and are aware of what has flowed from it, to ensure that we have sufficient checks and guidance to make sure that vasectomy does not go into an irresponsible private sector but is contained within the State sector so that it is unlikely or improbable that it will do harm to those who submit to the operation.

Mr. Biggs-Davison

Surely this is the whole purpose of the new Clause, to provide that if this happens it happens in the best possible way with the best possible safeguards.

Mr. Abse

I am making it clear that I do not think that is the purpose of the new Clause. Although the hon. Member is pressing me to be more explicit, I believe that neither hon. Member wants this Bill, and since they do not want it I am bound to assess the new Clause in terms of whether it is genuinely intended to bring about the result they claim or whether it is a filibustering, negative exercise.

Mr. Fell

The hon. Gentleman is the soul of courtesy as always. He will be remembered by all of us in Committee, but it was not very kind of him to suggest that this Clause is simply filibustering. Had it been thought to be so it would never have been accepted. It is true, and we have said so openly from the very beginning, that we are opposed to the Bill, but there is nothing to stop us trying to improve it. Surely the hon. Member agrees with that?

Mr. Abse

I will accept what the hon. Gentleman says. I am bound to test whether it is a genuine attempt to improve the Bill or whether it is an attempt to sabotage it. The hon. Member is too frank and too honest not to enable me to make that comment without his excessively demurring. I have to consider whether the important statement made by the Under-Secretary sufficiently assuages my doubts about supporting the course he suggests or whether I should turn to the alternative of the new Clause.

I am grateful to the Under-Secretary for the manner in which he has made it abundantly clear that there is intended to be certain aid for local authorities in an administrative and medical circular. I am certain that this would not have come about with the precision and clarity that we now have if it had not been for the hon. Members for Yarmouth and Chigwell being so persistent in Committee. We must accept that the cautionary words we have used have brought about what is an unusual course for a Minister to take, to give in advance in such terms a clear account of what type and nature of circular will flow from the passing of this Measure.

I am particularly grateful, and I think that the hon. Members will be grateful because it comes from their work, that we now have a statement making it clear that the caveatswe entered in Committee against the nature and character of counselling—if it was not of a wholly sensitive and insightful kind—have brought a response from the Under-Secretary. The fact that he is prepared to set up an advisory committee gives me some assurance. I hope that committee will contain those representing urologists who have a special knowledge of the matter, and I hope that the committee will look for guidance to people such as psycho analysts, within their Institute of Psycho-Analysis in particular. Both urologists and psycho-analysis have already made clear from their contributions on the subject that they fall into a special category in the character of the counselling that can be given. What can flow from the work of this committee is an improvement in the advice now given by the Family Planning Association and other institutions, and I, therefore, welcome it.

I am sure I am representing the view of those who came to me from the British Medical Association and the Medical Defence Union when I say that they are bound to express thanks to the Minister for having quite clearly given careful and considered thought to the representations which have been made through me. What he said about the concern regarding failed vasectomies will allay most of the anxieties of the Medical Defence Union, which would be the first to recognise that the setting up of the committee on advice and counselling will be a contribution to making it unlikely that there will be failed vasectomies, because there is a necessity for post-vasectomy as well as pre-vasectomy counselling and advice.

I believe that we can move forward without this Clause with a sense of assurance that the Bill will make a genuine contribution to family happiness and good family planning and that it is not likely only to yield to morbid masochism in the community.

Mr. Whitehead rose—

Mr. Deputy Speaker

Mr. Fell.

1.30 p.m.

Mr. Fell

I apologise if the hon. Member for Derby, North (Mr. Whitehead) wished to speak. I should have loved to have heard him before I made a second speech.

I cannot be happy about the situation which has arisen over the new Clause. It would be wrong of me to weary the House with tedious repetition, but I must admit that I am very disappointed about what has happened.

I wish to say a few words about the characteristically helpful speech of the hon. Member for Pontypool (Mr. Abse). I cannot understand why he is happy about the Under-Secretary's answer concerning sensitive counselling. I do not propose to read extracts from the hon. Gentleman's speech on counselling into which he put so much work, but the Minister has not said anything which makes me happy about the kind of counselling which will be available.

The hon. Member for Pontypool talked about failed vasectomies. The Under-secretary also referred to that. I believe he was able to refer to it only because the hon. Member for Pontypool was kind enough to let him have a copy of the document which had been sent to him by the medical authority concerned. I am sorry to say that I have not seen the document. The B.M.A., bless its heart, did not have the courtesy to send a copy of it to my hon. Friend the Member for Chigwell (Mr. Biggs-Davison) or myself, who were at that stage the only opponents of the Bill.

I am pleased that the hon. Member for Pontypool is satisfied that what the Under-Secretary said about failed vasectomies was all right. However, I beg leave to have some doubts about it. It would, however, be wrong for me to discuss, in the presence of the hon. Lady the Member for Halifax (Dr. Summerskill), with all her experience, the question of failed vasectomies. I do not know the figures concerned because I have not been given the relevant information.

I have some major bones to pick with my hon. Friend the Under-Secretary of State, who could not have shown more kindness and courtesy in Committee. He said, as though it were an excuse for supporting it, that the Bill will run only to 1974 and that therefore we need not worry. But he gave the game away because he said that the Bill had had a Second Reading and that therefore the will of the House had been demonstrated. I should not have thought that the Second Reading of a Private Member's Bill on a highly controversial but general subject like this which took place on a Friday when very few Members were present could by the wildest stretch of the imagination be regarded as giving a blessing to the Bill.

What worries me enormously is that my hon. Friend the Under-Secretary has said that the Bill, when it is an Act, will come to an end in 1974 and I do not know whether, when that happens, a new Bill will have to be presented or the matter can be dealt with by the Department issuing regulations. By 1974 matters will be well under way and vasectomies may be running at the rate of 20,000 a year. Can my hon. Friend tell me whether a new Bill will have to be introduced if the Department wishes to do that?

Suppose, however, that a Private Member wished to introduce a new Bill—perhaps the hon. Member for Derby, North, who has taken so much trouble over the Bill. If he wished to introduce a Bill at the end of 1974 or in 1975, it would be said that a similar Bill had been passed by the House with acclamation once and therefore it could be tackled without any trouble. That would be a most extraordinary way of proceeding in a democracy. We have surprises every five minutes in the House. This is perhaps the second this morning.

We did not divide against the committal of the Bill to a Committee upstairs. We always try to facilitate the wishes of the hon. Member for Derby, North, and therefore I shall not keep the House for more than another minute or two. But without being accused of tedious repetition I should like to know what my hon. Friend the Under-Secretary of State means when he talks, presumably with the advice of his Department, about "a completed family". I simply do not know what that term means. I know that in practice a family is completed is when either the father or mother is not able to conceive. But the vasectomy method of completing the family may apply even to a young married couple.

My hon. Friend has been kind and helpful, as he always is. He is a Christian man with the greatest morals and principles, but suppose we have someone sitting in his chair in 10 years' time who has different ideas about principles and morals. Suppose there is a Minister sit ting there who sees that the birth figures have gone up; suppose we have a crank sitting on that bench—

Mr. Speaker

Order. I tried a little while ago to get the hon. Member to talk about the circular. I know he is a man of his word, and he has just said that he will be speaking for only a moment or two.

Mr. Fell

I am getting carried away with the subject, Mr. Speaker. A vasectomised Bill has been sent down to us and it is so much the worse for that. I just wish to say something on the question of the completed family to which the Minister referred.

Mr. Speaker

We have heard quite a lot from the Minister and from the hon. Member.

Mr. Fell

I want to know what safeguard there will be. How long will it be before there is a statutory "completed family"? How long will it be before a completed family is a family with two children or three children? I have tried to express the fears which my hon. Friend the Member for Chigwell and I have at the back of our minds about the moral outlook towards society Let me not be a moraliser, because I cannot ever aspire to that. The hon. Member for Pontypool is right when he says that I am against the Bill. The Minister has turned down the new Clause without making any suggestions about what might replace it, but I hope he may be able to give us later assurances of help on other parts of the Bill.

Mr. Whitehead

After a full debate which has ranged far, from the fears of the hon. Member for Yarmouth (Mr. Fell) and his hon. Friends through brief excursions into the classics, autobiography, memoir and history from the hon. Member for Glasgow, Hillhead (Mr. Galbraith), it might help if I attempted to sum up the impression left on me by the valuable contribution made by the Minister. We all have a debt of gratitude to the Minister for the way in which he and his advisers have sympathetically followed the course of the Bill throughout and have attempted to meet the wishes of the Committee.

My understanding, as a comparatively new Member of Parliament, is that the whole purpose of the Report stage is to build upon the creative conflicts in Committee, and that is what we have done. In that context I pay tribute to my hon. Friend the Member for Pontypool (Mr. Abse) and others who have shown some of the problems which might arise if vasectomy, as the hon. Member for Yarmouth might say, were to get out of hand.

We have always made it clear that vasectomy would never be the primary method of birth control and that we never intended it to be more than an operation which should be available, regardless of cost, on their own free judgment—there is no question of Moscow-like decisions—to people who, as the hon. Member for Oldbury and Halesowen (Mr. Stokes) said, had decided that their families were complete. If the hon. Member for Yarmouth disagrees and thinks that people are not in a position to say this, that is for him, but those of us who feel that free men can make this decision—after all, the Bill refers to voluntary vasectomy—have been heartened by what the Minister has said.

As I understand, the parent Act contains in Section 1 (1) the words: with the approval of the Minister of Health". There is, therefore, no doubt that any clinic, advisory service or hospital service provided under the Bill by the local authority would have to meet the full approval of the Secretary of State before it could stay in the business of performing these functions.

1.45 p.m.

I accept what the Minister has said about the delicate relationship between local authorities and the Secretary of State. I am glad that the administrative circular will draw attention to the fact that this is normally an operation for married men or those in stable unions—I hope the words "those in stable unions" added in parenthesis by the Minister will find their way into the circular—and to people of mature years who have completed their families. I am glad also that local authorities will be recommended to look carefully at the motives of younger men who come forward for the operation. I accept that consent is of the essence of the Bill and that the consent of both partners should be given before the operation is undertaken.

I welcome the setting up of an advisory group to prepare expert advice on counselling for the medical officers of health. I hope that it will contain amongst the parameters within which it can give advice the question of the processes which are to be entered into in the counselling procedure—the fact that referral, for example, should normally be by the general practitioner since he will know the family situation better than anyone else, and that discussions will be entered into.

I suggest that the processes recommended by the advisory group should include particular stress on the follow-up procedure, counselling and advice where necessary afterwards as well as before, and, of course, the full and proper procedure for ensuring that the operation is successful.

The majority of the cases referred to in the letters which were sent to my hon. Friend by the Medical Defence Union were adjudged failures only in so far as the people concerned had not been told that the vasectomy operation was not successful unless two successive negative sperm counts had been obtained. That procedure is more likely to take place outside the aegis of the local authority health services and the National Health Service, and the procedures to be followed if we consider the advice given by the Family Planning Association and the Simon Population Trust on what the patient must be told and what procedures he must follow are laid down already. Those procedures should be followed by the local authorities when the Bill becomes law.

I believe that the vasectomy clinics will have the minimum demanded by the B.M.A. and in some matters will probably have greater standards of care than is the case now in private practice. I also hope that the point will be well taken about bringing all these services within the aegis of the National Health Service and providing proper back-up facilities, including hospital beds, where needed, for all patients.

In considering the new Clause we must take into account what was said by my hon. Friend the Member for Pontypool Does the hon. Member for Yarmouth wish to strengthen the Bill or not? On the one hand he appears to be asking for no State intervention, and on the other hand he seems to be saying that State intervention should be strengthened. He also appears to be giving his advice on correct procedures for this operation which would facilitate the proper undertaking of the operation when, as we heard in Committee, he is entirely opposed to the whole notion of the operation and even questions its legality.

Mr. Fell

I tried to spell out this matter to the hon. Member for Pontypool (Mr. Abse). Surely it must be clear that even though the new Clause may be badly drafted and even unworkable, it nevertheless attempts to do a job. If the

Division No. 102.] AYES [1.55 p.m.
Galbraith, Hn. T. G. TELLERS FOR THE AYES::
Hornsby-Smith,Rt.Hn.Dame Patricia Mr. Anthony Fell and
Stokes, John Mr. John Biggs-Davison
NOES
Abse, Leo Hattersley, Roy Rees-Davies, W. R.
Albu, Austen Houghton, Rt. Hn. Douglas Roper, John
Alison, Michael (Barkston Ash) Huckfield, Leslie Rost, Peter
Allen, Scholefield Jenkins, Hugh (Putney) Sandelson, Neville
Atkins, Humphrey Jessel, Toby Short, Mrs. Renée (W'hampton,N.E.)
Atkinson, Norman Johnson, James (K'ston-on-Hull, W.) Silkin, Hn. S. C. (Dulwich)
Baker, Kenneth (St. Marylebone) Johnson, Walter (Derby, S.) Silverman, Julius
Barnett, Guy (Greenwich) Judd, Frank Sinclair, Sir George
Blenkinsop, Arthur Kaufman, Gerald Spearing, Nigel
Brown, Ronald (Shoreditch & F'b[...]ry) Kelley, Richard Spence, John
Clark, David (Colne Valley) Lane, David Stewart, Donald (Western Isles)
Clegg, Walter Leonard, Dick Stewart, Rt. Hn. Michael (Fulham)
Cormack, Patrick Lestor, Miss Joan Stuttaford, Dr. Tom
Cunningham, G. (Islington, S.W.) Lipton, Marcus Summerskill, Hn. Dr. Shirley
Davies, Denzil (Llanelly) Mackenzie, Gregor Taverne, Dick
Davis, Terry (Bromsgrove) Mackle, John Tomney, Frank
Deakins, Eric Mendelson, John Trafford, Dr. Anthony
de Freitas, Rt. Hn. Sir Geoffrey Meyer, Sir Anthony Urwin, T. W.
Edwards, Robert (Bilston) Mikardo, Ian Vaughan, Dr. Gerard
English, Michael Miscampbell, Norman Walker-Smith, Rt. Hn. Sir Derek
Eyre, Reginald Moate, Roger Weitzman, David
Fletcher, Raymond (Ilkeston) Molloy, William Wellbeloved, James
Gilbert, Dr. John Neave, Airey Whitehead, Phillip
Golding, John Ogden, Eric Williams, Alan (Swansea, W.)
Grant, Anthony (Harrow, C.) Parker, John (Dagenham)
Grant, John D. (Islington, E.) Peel, John TELLERS FOR THE NOES:
Gummer, Selwyn Pendry, Tom Mr. William Hamling and
Hamilton, William (Fife, W.) Rankin, John Dr. David Owen.

Question accordingly negatived.

Under-Secretary or the hon. Gentleman wanted to exchange it for something else, they could have suggested an alternative at any time. It is not worthy of the hon. Member for Derby, North (Mr. Whitehead), who has been most helpful throughout the Bill, to suggest that the new Clause has been tabled for fun and games, because there is no fun and games about this matter where I am concerned.

Mr. Whitehead

I share the hon. Gentleman's serious approach to these matters, and it is obvious that there is a difference of opinion between us on his new Clause. If we had wanted such a provision, we would have sought to write it into the Statute.

I am happy with the undertaking given by the Under-Secretary. Because of the hon. Gentleman's sympathetic outlook I know he will take seriously into account what has been said this morning, and, therefore, I have no hesitation in advising the House to reject new Clause 3.

Question put, That the Clause be read a Second time: —

The House divided: Ayes 3, Noes 80.

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