PROVISION OF VOLUNTARY VASECTOMY SERVICES (Hansard, 24 March 1972)

§ Mr. Biggs-Davison
I beg to move Amendment No. 2, in page 1, line 6 after 'may', insert: 'on payment of a fee except in cases of medical necessity'.

§ Mr. Speaker
With this Amendment we are also considering Amendment No. 9, in line 19, at end insert: 'and at the end of that subsection there shall be added the words— Provided that such a charge shall always be recovered in respect of vasectomy services unless such services are provided for reasons of medical necessity" '

§ Mr. Biggs-Davison
I shall be brief in introducing the Amendment. I am very sensitive of what was said by the hon. Member for Pontypool (Mr. Abse), who indicated that there might be an element of filibuster in the debates on some of the Amendments that the Chair thought fit to admit to the Report stage. I wish to remove any such misapprehension. After all, I am the hon. Member who closured his own speech in Standing Committee and thus, I believe, made parliamentary history. So I do not think there can be any element of filibuster in our proceedings. If the hon. Gentleman cares to examine the Official Report of the proceedings in Committee he will see that I did not take up much time.
I am anxious also to remove the curious impression that because an hon. Member is opposed to the principle of a Bill he should not be concerned to improve it. If an hon. Member dislikes a Bill in principle and is concerned to circumscribe some of the effects of it and to make others of them less obnoxious, it is his duty as a Member of this House to try to do so.
This Amendment is concerned with payment for vesectomy operations for the purposes of contraception. I think that that is quite a reasonable proposition. I accept the view that those of us who do not like a law are expected to obey it and that very often citizens have to pay through their rates or taxes for services of which they do not approve. That is understood, and it is normal. Pacifists help to pay for the Armed Forces, and 1914 people who hold my view of this matter very often have to subscribe to services of which they do not approve. But I do not see that there can be any objection to this Amendment.
At the moment payments are made for vasectomies. There was an interesting article in yesterday's Daily Mirror by "Mirror Man Steve Turner" on vasectomy. I think that the intention was to prepare the House and the public for this debate. One of the questions that he asked and answered in his article was: How much does a vasectomy cost? The answer that he gave was as follows: There is no standard fee. Family Planning Association vasectomy clinics (there are seventeen now, with more planned) have been charging £15.50 for counselling and surgery From 1st April, the cost via F.P.A. goes up to £21. Some doctors do vasectomies for £25–£30. One man is known to have paid £125 for his operation. The average waiting-time for a vasectomy at an F.P.A. clinic is now four months. I suppose that the implication is that if there is a queue and someone is in a hurry he may be expected to pay a doctor who requires a larger fee.
I do not believe that the payment of fees is objectionable whether the operations be done in the private sector or otherwise. After all, the sums of money being paid at present are not formidable when one considers that it is a once-for-all operation. Indeed, one of the complaints that we have about it is that it is a once-for-all operation. I do not think that anyone could reasonably object to fees being charged under the provisions of this Act, if the Bill is enacted, and it would also help remove some of the objections of those who say that they do not wish to see this service provided purely at the ratepayers' expense.
I accept the proposition that ratepayers and taxpayers may have to pay for services of which they disapprove thoroughly, but on the whole this Amendment seems reasonable and helpful to those ratepayers who do not approve of this at all and who take the view of the Bill that my hon. Friend the Member for Yarmouth (Mr. Fell) and I do.
If it is said that there are people who will not be able to pay a modest fee 1915 such as that mentioned in the Daily Mirror article for an operation which is once-for-all and a matter which should give pause to the person contemplating it, it is a good idea that some pause should be given, and this would be one of the results if the Amendment were accepted.
I hope that the hon. Member for Derby, North (Mr. Whitehead) will see his way to accepting the Amendment. It is wholly reasonable. It can do no harm to anyone, even to the most enthusiastic supporter of the Bill.

§ Mr. Galbraith
I support my hon. Friend the Member for Chigwell (Mr. Biggs-Davison). I can see no reason why a fee should not be exacted except in cases of medical necessity. The hon. Member for Brixton (Mr. Lipton) made a very interesting speech earlier when he told the House the costs of this operation, which he said ran at between £30 and £40. That sounds a lot of money, but we are all very old-fashioned. It is not a lot of money at all. It represents about one week's wages.
Most people could well afford that sort of money for an operation which is not necessary. After all, the Amendment says except in cases of medical necessity. Where it is not necessary on medical grounds, why should the man having the operation not make this small contribution? It is no good hon. Members opposite saying that the proposed fee is not small. It is small, and they know it.
This proposal questions the whole purpose of the National Health Service and what it is meant to do. Is it for health only? Is it to help people who are in medical need, who need medical help not only from a medical point of view but from a financial point of view? Or is it for other ancillary purposes? Is it for improving the look of one's face, for example, or, if my hon. Friend the Member for Chigwell will forgive me, for things like toupees—he and I are beginning to get into the same state—tattooing, and so on?
I believe that the National Health Service should be reserved for health matters, not for other things. What I have said applies to my hon. Friend the Member for Oldbury and Halesowen (Mr. Stokes) 1916 —I hope he will forgive me—and, indeed, from my vantage point, to the Minister himself. His hair is not as thick as it used to be. There may be something to be said for the 18th century—perhaps I am going rather wide. At any rate, the National Health Service should be not for people's convenience or vanity but for matters which are necessary from a medical point of view.
The proposer of the Bill, who unfortunately is not here—

§ Mr. Abse
I am taking note.

§ Mr. Galbraith
I am delighted that the hon. Member for Pontypool (Mr. Abse) is at this moment taking charge of the Bill.

§ Mr. Abse
I am merely taking note.

§ Mr. Galbraith
Is the hon. Gentleman going to reply for his hon. Friend? Are we to have no reply from the other side of the House? This is rather a serious matter.

§ Dr. Summerskill
My hon. Friend the Member for Derby, North (Mr. Whitehead) told me that he would be returning any minute.

§ Mr. Galbraith
Unfortunately, he did not make arrangements about his sandwich. Perhaps he is munching it in the Lobby. I sympathise with him. Meanwhile he is missing the point.
I wanted to ask the promoter of the Bill: what are the sums involved? If the Amendment were accepted, how much would it save the public purse? I have looked at the effect of this matter on the ordinary individual. I believe that £30 to £40 is not beyond the capacity of somebody who wants this operation not on grounds of medical necessity but because he would like it. This is not what the National Health Service exists for.
I realise that there is a basic conflict in philosophical approach between the two sides of the House on what the National Health Service should be for. I believe that it should be for medical necessity. I go even further—I do not necessarily expect to carry my hon. Friends—and say that where a person can pay, even incases of medical necessity, there is a strong argument for saying that he should. 1917 I support the Amendment. I very much hope that some hon. Gentlemen opposite who support the Bill will be able to deal with the small points which have been raised. If it is to be the hon. Member for Pontypool, nobody could be more grateful than I because I recognise that he is an authority on these matters and speaks with a wealth of knowledge for which the House is greatly indebted.

§ Mr. Abse
I well understand the motivation behind the genuineness of the Amendment. Nobody should have the idea that in any matter where there could be self-help there should be a subsidy. That is the view behind the Amendment, and it is one which I share.
Through my association with the parent Act, the National Health Service (Family Planning) Act, 1967, there is no question but that the decision whether payments are made, in what circumstances they are made, whether there is a means test or whether people are financially screened, is entirely for the local authority concerned. Under the National Health Service (Family Planning) Act, 1967 practices vary in different parts of the country whether payment is made, whether advice is given free and whether contraceptives are charged for. Therefore, we are not taking away the discretion from local authorities which will be deciding about the circumstances in which payment may have to be made. I think that most local authorities will take the view—there may be some which will not—that they will assess each case in turn to decide whether payment should be made.
The misunderstanding which has prompted the Amendment is that we could do a great deal of harm if we did not save the community a great deal of money by allowing this operation to be carried out free in what I hope are special and particular circumstances.
2.15 p.m.
One of the main objects of the parent Act—it will apply here, to—is that for the first time the opportunity for domiciliary visits was given. It provided the opportunity for social workers and medical officers to seek out the problem families and, in seeking them out, to advise and counsel them. I do not imagine that it would be the wish of the House, if vasectomy is to be available, 1918 to exclude it from the problem family with six or seven children, which is a grave charge and burden to the State. For example, it may be that the wife is regularly asking for an abortion because she cannot face the prospect of bringing another child into slum conditions, or bringing into being an extra burden, or because her husband may be indifferent or feckless. It is precisely in those circumstances where we would want to make certain that vasectomy could take place without debarring the man, who may otherwise accept it, by insisting upon payment of a sum of money.
I expect that, knowing their natural shrewdness, local authorities will take decisions which will mean that contributions towards the cost will be taken in certain cases. However, I am particularly concerned about families which are a heavy burden to the community. Often a woman who has had a large number of children now demands an abortion. It is precisely in that area that there must be discretion to allow a free vasectomy. I hope that that view will not conflict with the reasonable presentation of the case which the hon. Member for Chigwell (Mr. Biggs-Davison), in his succinct, not filibustering, speech, brought to the question. I think that we would be operating against the very people we want to help with the possibility of vasectomy if we accepted the Amendment.

§ Mr. Fell
The hon. Member for Pontypool (Mr. Abse) has missed out the care which the State has for the very poor and needy. If ever a Government have tried to show that they will help the poor and needy, it is this Government.
The hon. Gentleman always puts his argument so immaculately and with such thought and care that it is difficult to fault them in any respect. But I wonder whether he really meant what he said about the problem family where the wife was being given a child every year and the husband was a feckless so-and-so Surely he did not think that we should make a great charge—he did not say "great"—on such families for this kind of operation. They are the very families where the husbands will be advised to have a vasectomy. I do not want to lake a party point, but it would be ridiculous to suggest that no Government have not made charges for medical reasons of one kind or another. One can remember 1919 cases where charges for prescriptions were imposed, and not only by the Conservative Party. It has been accepted that there should be charges in certain circumstances for health services of one sort and another.
I agree that where a family really needed help in this way and where, after consultation in the manner suggested by the hon. Gentleman, it was thought that a vasectomy was the right thing to do, rather than having something done to the wife, which is a horrible thought, it would be monstrous to charge. Surely no one can suggest that the State would not be able to find a means of helping that poor family. Under the present Government, such a family is unlikely to be really a bread-line case if it has so large a number of children, and it is quite unthinkable that there would be a charge of £20 or whatever it might be for the operation.
I disagree with the hon. Member when he attempts to suggest that my hon. Friend the Member for Chigwell (Mr. Biggs-Davison)—perhaps the most humane man on this side of the House—and even myself have such diabolical minds that we would advocate that someone for whom it was necessary but who could not really afford it should nevertheless have to pay.
The Amendments have not been read out to the House. Amendment No. 2 simply states: in page 1, line 6, after 'may', insert: on payment of a fee except in cases of medical necessity'. It seems to be harmless enough.

§ Mr. Whitehead
It is not.

§ Mr. Fell
The hon. Gentleman says that it is not. But he is trying to get the Bill through. Is every Amendment that we try to argue to be considered so irrational and impossible that it must be turned down out of hand? There has been no attempt by the hon. Member for Derby, North (Mr. Whitehead) to alter the Bill back to where it was on Second Reading. If there had been, we might have been happier. Does he expect us, if he turns everything down out of hand, and if my hon. Friend the Under-Secretary of State does not move towards us, to sit down and watch the Bill simply 1920 trundle through the House? Will the hon. Gentleman support these Amendments?
Amendment No. 9 has not been read out to the House either. It says: in page 1, line 19, at end insert: 'and at the end of that subsection there shall be added the words— Provided that such a charge shall always be recovered in respect of vasectomy services unless such services are provided for reasons of medical necessity"'. It shows the reasonableness of my hon. Friend the Member for Chigwell and, I hope, of myself. I fail to understand why, throughout the proceedings on the Bill, after all that has been said, no move of any sort has been made towards those who represent not vast numbers but a substantial opinion in the country, and who represent what we believe to be the right thought.

§ Mr. Biggs-Davison
Is it not notice able that the hon. Member for Pontypool (Mr. Abse), who voted with us against the removal of the 30-year age stipulation, is taking no steps to reinstate that age limit although he considered it essential to the Bill and said that the hon. Member for Derby, North (Mr. Whitehead) had practically lost the Bill because of it? Is this not extraordinary obduracy and a failure to respond to the wishes of the Standing Committee and to fulfil his own wishes? This is an extraordinary attitude.

§ Mr. Fell
What is more it shows the enormous faith of the hon. Member for Derby, North, which is not normally apparent, in the Government, because his proposition—

§ Mr. Whitehead
I would be out of order in answering the hon. Member for Chigwell (Mr. Biggs-Davison) because Amendment No. 8 has not been selected. It stands in the names of the hon. Member for Chigwell and the hon. Member for Yarmouth (Mr. Fell).

§ Mr. Fell
I am talking about Amendments Nos. 2 and 9. I am sorry if the hon. Gentleman looked at the wrong one. It is a mistake any of us can make. In trying to gain support for these two Amendments, I was remarking on the in credible fact of the amount of trust which the hon. Gentleman places in the Minister. It has never been seen in him before. But we have also seen it in the 1921 hon. Member for Pontypool. Perhaps the hon. Member for Pontypool is more in the habit of putting his trust in Government Ministers, but I have not particularly noticed it.
However, I do not want to delay the Committee. Time rushes by. One can hardly stop the minutes going by and it would be churlish of me in any way to attempt to filibuster. What I am trying to draw out of the hon. Member for Derby, North or out of my hon. Friend the Under-Secretary of State, or both, is some recognition that my hon. Friend the Member for Chigwell and I have got a point. We have not had a single recognition since the beginning of the Bill that those who oppose it have any point on which to stand. I am sure it is right—

§ Mr. Speaker
Order. The hon. Gentleman must confine himself to the Amendment. The Chair is not allowed to hold any view of any Bill, but I am beginning to wonder whether a glossectomy Bill might not be a good idea.

§ Mr. Fell
With respect, Mr. Speaker, we had considerable trouble in Committee, which you know about only from reading the Official Report, because we were only two. Today our vote showed that we are three strong, at least in the Lobby. We had enormous trouble in Committee in trying to get our view across. It is a minority view but it is none the less important for the fact that it is a minority view.

§ Mr. Galbraith
Figures can be made to prove anything. It is well known that when a Division takes place in the middle of the lunch hour hon. Members, being human, see one of their friends and, with out thinking too much about it, go through the Lobby—

§ Mr. Speaker
Order. Even interventions must be in order. I was not seeking to curtail the hon. Member for Yarmouth (Mr. Fell) but was warning him to address his speech to the Amendment.

§ Mr. Fell
While hastening with alacrity to comply with your ruling, Mr. Speaker, I point out that I have at least done the House the courtesy of reading out the Amendments so that we might know what we are talking about in full. I also remind the House that I am using extraneous speech only because I cannot go on saying "Please, I want this Amendment," 1922 since you would then immediately call me to order for tedious repetition, and rightly so. Surely I am at least to be allowed to put a case when I see those whom I am trying to impress looking so dumb and stupid. [Laughter.] Well, at least I have got a laugh. The hon. Member looks a little more helpful.
I shall be glad of any sign of assistance from the hon. Member for Derby, North or the kind Minister, who has been helpful throughout. Is it not something to be kind in all one's dealings with one's fellow Members? It is quite another thing to be kind in practice. All I want is some kindness in practice, some gesture to show that the Minister will not let the worst happen. He could start by saying that he will find a way of making charges for these operations in the National Health Service or wherever they are done, except, of course, in those cases where there is real hardship, which neither my hon. Friend nor I would dream of doing.

§ Mr. Alison
I am faced with the onerous task of both keeping in order and attempting to recover the normative smile upon the face of my hon. Friend the Member for Yarmouth (Mr. Fell).That is a difficult task to perform.
I listened with sympathy to my hon. Friend's view that he had a frustrating task in Committee in seeking to bend the general direction of the Bill more in the sense that he and his hon. Friend would wish it, but I ask him to ponder carefully the words of the hon. Member for Pontypool (Mr. Abse) when he rehearsed the extent of the Government's obligations in communicating with local authorities. The assurances which we have found it necessary to give are a full and explicit recognition of the sensitivity which we have felt towards the arguments of my hon. Friends. We have recognised—they have often spoken in harmony with the hon. Member for Pontypool—that their points are important. My earlier undertakings reflect this.

§ Mr. Deputy Speaker (Mr. E. L. Mallalieu)
Order. It seems to the Chair that the Minister is now doing what Mr. Speaker asked him not to do.

§ Mr. Alison
Of course I accept that ruling, Mr. Deputy Speaker, and I hope that what I have said so far will recover my hon. Friend's sense of well-being.

§ Mr. Fell
I am grateful to my hon. Friend for taking such trouble with me. After all, why should he? That is not an assurance. All he has done is tell me that the hon. Member for Pontypool (Mr. Abse) is happy. That does not reassure me, bless his heart. I think he has been marvellous on the Bill, but I am not reassured to know that the hon. Member for Pontypool is happy.

§ Mr. Alison
I am afraid that I must now press on and address myself to the Amendments.
The sum of them is that a charge should be the normative thing for social as distinct from medical cases and that fees will always be charged, so that remissions cannot be made on grounds of hardship. This is the effect of Amendment No. 9.
The vasectomy operation is already available under the National Health Service on medical grounds. If it is proposed, as the Bill proposes, that vasectomy should be available now under local authority sponsorship, it is certainly likely that the applicants whom local authorities will most actively and conscientiously want to consider will be those who want to come forward on social grounds—very large and very poor families.
It is against this background that I must ask the House to reject any Amendment that would exclude social cases—that is, almost by definition, large, poor families—from a subsidised service. The resources available for this operation, particularly in terms of medical manpower and facilities for the operation, will of necessity limit the number of cases for which a local authority can provide. I would therefore expect that only those with a very strong social need would be provided for in this way—again the large families and pre-eminently the very poor ones.
The effect of counselling and selection which, as I have suggested, we shall ask local authorities to do will also be to limit the availability of the operation to those in greatest need in social and, therefore, in financial terms. It would be totally unreasonable to expect that sort of man to pay for the operation.
My right hon. Friend the Secretary of of State has not yet reached a decision on charges but, subject to consideration of any view expressed by the local authority associations, he is seriously 1924 considering whether he should approve charges at all for this operation because of the undesirability of introducing a financial distinction between hospital-and local authority-sponsored operations under the National Health Service.
If the Bill is to give effective powers to local authorities in this matter, it is almost certain that those whom they will wish to help will be large, poor families whose need arises primarily on social grounds. We must have provision to be able to subsidise and remit charges to them. I must therefore ask the House to reject both these Amendments.

§ Mr. Fell
My hon. Friend says that because it would be wrong to make a charge to a problem family, and this would mean that such a charge was made, everybody else must go free as well. That is putting it the other way round. Is it really beyond the wit of the Government to find a way of paying for a vasectomy for the type of family my hon. Friend is talking about?

§ Mr. Alison
I must ask my hon. Friend once again to bear in mind the terms of his own Amendment. It is explicit that a charge shall invariably be made and then recovered—this means from the person undergoing the operation. For this reason the poor, needy family would necessarily be charged.

§ Dr. Summerskill
The Minister and my hon. Friend the Member for Pontypool (Mr. Abse) have put very clearly the problem which would arise if one had to charge poor families who lived in bad housing conditions and had a large number of children or else had to ask local authorities to impose yet another means test. There are already 49; this would be the fiftieth means test.
One of the most persuasive arguments of the Minister was that under the National Health Service any hospital vasectomy, whether on medical grounds or, less frequently, on social grounds, is free at the time it is done. Therefore, it would discriminate against those who have this operation on the National Health Service under local authority auspices if they were charged while other people who may have the luck to get into a hospital in their area and have the same operation done for the same reason—either medical or social—did not have to 1925 pay. This would seem to be unfair discrimination against those who have the operation under local authority auspices.
Large families are nearly always less well off with poor social and housing conditions. Considering that they would either have to pay or have a means test to avoid paying, the fairest way to finance this operation would seem to be through the rates, under the direction and control of the local authority.

§ Mr. Whitehead
This Measure would have no purpose unless it enabled the provisions of the National Health Service to be extended in this way for the poor and the very poor. It is to that end that the sponsors of the Bill originally introduced the Measure.
I remind the hon. Member for Chigwell (Mr. Biggs-Davison) that the parent Act is specific in allowing a local authority to make charges for this operation if to do so seems desirable. I need do no more than tell the hon. Gentleman and those who support the Amendment that they must consider its effect on Section 1(2) of the National Health Service (Family Planning) Act, 1967, which says: A local authority may, with the approval of the Minister of Health, recover from persons to whom advice is given under this section or substances or appliances supplied there under or from such persons of any class or description such charges (if any) as the authority consider reasonable, having regard to the means of those persons. That is eminently clear, particularly when taken with what the Minister said about the way in which the local authority must look at the problems of the very poor who come forward for this operation and who should not in those circumstances be charged. The Amendment would simply add another barrier between those people and their having proper access to the operation. That would be bound to occur if we began trying to write into the Bill distinctions between medical and social grounds in the way that some hon. Members suggest.
I trust that the hon. Member for Chigwell appreciates our concern in this matter. After very careful checking among some of the family planning clinics where vasectomies are carried out, I discovered that the question of follow-up procedures is a matter causing some concern. I was told that the only time that concern is felt is when a person 1926 who has had the operation has not made himself available for the subsequent tests, because he either did not want to pay or could not afford to pay.
It would be ridiculous if, having brought this operation within the provisions of local health authority services, it were made harder for people to make themselves available to clinics and hospitals for the necessary follow-up procedures—sperm tests and so on—after the operation but before it has been pronounced a success. I therefore join with the Minister in urging the House to reject the Amendment.

§ Mr. Biggs-Davison
The hon. Member for Derby, North (Mr. Whitehead)was so persuasive and courteous in the presentation of his case that I almost felt like begging leave to withdraw the Amendment. Unfortunately, however, he concluded his admirable comments by showing crusading zeal for vasectomy and issuing a proselytising call for yet more vasectomies. How terrible it would be, he said, in effect, if someone who might want to be vasectomised were discouraged from having the operation. I shall, therefore, resist the temptation to withdraw the Amendment.

§ Mr. Whitehead
I did not say that. I said that I was concerned that the operation should be as available to the very poor as to the well-off. That is a concern for social equality.

§ Mr. Biggs-Davison
Although I oppose the Bill, I appreciate and sympathise with those remarks.
The hon. Member for Pontypool (Mr. Abse) thought it should be a matter for the local authority, and in this connection the hon. Member for Derby, North quoted Section 1(2) of the parent Act. The hon. Member for Pontypool spoke of the shrewdness of local authorities. In other words, he is prepared to leave it to them to decide whether to recover charges from persons having this operation. We think that local authorities should make recovery.
We do not in the Amendment specify a scale of charges or even ask for one to be laid down in regulations or elsewhere. The Minister said that if the Amendment were accepted charges would always have to be recovered. Perhaps 1927 so, but there are ways of giving assistance, and in cases where people could not afford the charges ways could be found to provide the money.
The arguments against the Amendment are not convincing, and I must, therefore, ask the House to divide on this issue.

§ Mr. Deputy Speaker
The Question is—

§ Mr. Biggs-Davison
On a point of order. Will you be granting separate Divisions for the two Amendments, Mr. Deputy Speaker?