§ It shall be the duty of the Secretary of State to provide for the provision of accommodation and other facilities, including financial assistance, for parents of children in hospital; and the Secretary of State may make regulations regarding the nature, mode and scale of such facilities and assistance.—[Dr. Summenkill.]
§ Brought up, and read the First time.
§ Mr. Deputy-Speaker (Sir Robert Grant-Ferris)
With this clause it will be convenient to discuss new Clause 5—[Reimbursement of travelling expenses of patients' visitors].
§ Dr. Summerskill
New Clause 4 covers a smaller category of people than new Clause 5, but it extends the help required.
The Committee debate on the subject covered by new Clause 4 was most instructive and constructive, yet the Opposition were not at all satisfied with the Government's reply.
The peculiar and special difficulties faced by parents when children are in hospital have given rise to the clause. There must be few hon. Members who have not had personal experience of these difficulties or have not received complaints from constituents.
Public opinion about it is being co-ordinated by the extensive activities and 1288 enterprise of the National Association for the Welfare of Children in Hospital. This consists not only of parents but of doctors, nurses, medical social workers and health visitors. The association is expanding rapidly, and it is now generally accepted that parents can play a vitally important part in the promotion of the recovery of their children, in improving their morale, in avoiding psychological trauma as a result of admission to hospital, and in learning about the aftercare of their children when they return home.
An inquiry was carried out recently by the National Association for the Welfare of Children in Hospital and a survey was made of specialist and children's hospitals which showed that 19 per cent. of children came from homes more than 20 miles away from the hospitals and that 7 per cent. came from more than 50 miles away. An inquiry over a period of 20 weeks by a medical social worker at a large orthopaedic hospital revealed that during this period eight out of 34 parents incurred travelling expenses of between £100 and £200 each.
The recommendations that we are making, therefore, are based not only on statistics of this kind but historically upon the conclusions of the very famous Platt report which was published as long ago as 1959 but of which there is general agreement on both sides of the House that there should be some implementation.
The existing provision of finances for travelling is varied and not at all satisfactory. The social security system makes an allowance to parents already receiving supplementary benefit if they 1289 can show cause and, in rare cases, assists people who are receiving very low wages. There are some local authorities which will give assistance on the recommendations of health visitors and social workers, but again this varies widely. There are some sick children's charities and leagues of friends which will assist in certain cases, but policies vary from hospital to hospital and branch to branch. Some hospitals allow their own welfare funds to be used. But the present system obviously is most unsatisfactory and unfair in many respects.
Accommodation in hospitals is the main provision in the clause. Accommodation, as we established in Committee, is basically accommodation overnight for one or other of the parents. From this would follow waiting rooms during the day, rest rooms and canteen facilities. But the point to establish primarily is overnight accommodation. There is slow improvement, but improvement nevertheless, in the provision of this accommodation.
I should like to draw attention to the figures for the Leeds hospital region which serves the constituencies of the Secretary of State the right hon. Member for Leeds, North-East (Sir K. Joseph) and the Under-Secretary of State the hon. Member for Barkston Ash (Mr. Alison). In February 1972 only 32 per cent. of hospitals in that region could offer beds to mothers and, if necessary, fathers. So there is great variation in the provision of accommodation in this sphere. Yet nursing staff are learning to care for children more as family units. Everyone now accepts that parents have an important rôle to play in the care of sick children.
The provision of travelling expenses is a discretionary power of local authorities, but there is an increasing need for help in this respect. Bus and train fares are for ever rising. Hospitals are becoming increasingly centralised and away from the local community, so that people living in rural areas often spend hours travelling to get to their children. There are specialist hospitals where a child may be forced to remain because it is suffering from a particular complaint, is a long-stay patient, or has sustained an 1290 accident in a particular area. Therefore, it is an increasingly practical problem, or an impossibility, for some parents to visit their children.
Professor Oppe, a paediatric adviser to the Department of Health and Social Security, at a recent conference of the National Association for the Welfare of Children in Hospital said:Fares assistance should not be considered as a hand-out on compassionate grounds, but part of the medical care of children and the medical care of families.I have had drawn to my attention the case of a father and mother in Leeds whose six-year-old son has been in hospital in Berkshire for many months. They were told by the medical social worker, who had no more money to give them, that they should restrict their visits to one a month. It costs those parents over £10 a visit.
We propose new Clause 4 as, a start in this matter, especially for long-stay child patients, but also for the acutely ill. New Clause 5 covers the worthy cases of geriatric patients who are also in great need of visits. As well as being medically desirable, these new clauses would introduce an element of humanity and compassion into a Bill which is riddled with management philosophy.
In Committee the Under-Secretary was full of reassurances, sympathy and understanding. He spoke picturesquely of the "hidden antennae" which go out from his Department into the administration of the hospital world. We found this most comforting, but not enough. We are concerned not only that guidance and encouragement on this matter should emanate from the Department but that a new clause should make it the firm duty of the Secretary of State under the new reorganised health service. We are concerned not only with creating a climate of opinion but with the definite cold print of a new clause.
§ Sir Robin Turton (Thirsk and Malton)
I have considerable sympathy for the argument put forward by the hon. Member for Halifax (Dr. Summerskill). In health it is always a battle of priorities. If hospitals are to have extra rooms for parents, particularly in the paediatric wings, there will be less hospital building.
1291 There is great difficulty particularly for children and geriatrics. It is a tremendous burden in geriatric cases, where old parents may be removed far from their homes, to encourage their children or grandchildren to visit them. It often means a tremendous expense on bus fares, or often hiring a car because there are few rural bus services. Therefore, I acknowledge the great need for better provision than we now have for both children and geriatrics.
How is that provision to be met? I think that this should be the responsibility of the Secretary of State for Social Services. There I agree with the hon. Lady. However, I do not believe that the cost should come from the hospital vote. Help is provided from the almoner's funds in hospital welfare. There is also power in local authorities to defray such travelling expenses in cases of hardship. There is a varied execution of that responsibility. I understand from the National Association for the Welfare of Children in Hospital that there is also power in the hands of the Supplementary Benefits Commission, but for some odd reason it apparently does not consider a case until a child has been in hospital for 12 weeks. I should like my hon. Friend to deal with that aspect when he replies.
There must be a complete review of the provision of travelling expenses and the costs of overnight stay for parents visiting children in hospital. It need not be "rooming in", as it used to be called; it could be the provision of accommodation for those who could not otherwise afford it. I believe that this matter should come under another hat of the Secretary of State rather than from the health Vote. I hope that in reply my hon. Friend will give us not merely sympathy but a definite undertaking that something will be done to meet this need, though not necessarily in the terms of the clause proposed by the hon. Member for Halifax or that standing in the name of my neighbour the hon. Member for York (Mr. Alexander W. Lyon).
§ Mr. Alexander W. Lyon (York)
The York branch of the National Association for the Welfare of Children in Hospital has been extremely active. It was as a result of its representations that I put down new Clause 5. Obviously, it has also been in touch with the right hon. 1292 Member for Thirsk and Malton (Sir Robin Turton).
The Association's approach to me was on the basis of the reimbursement of expenses to children's visitors. I thought that was too narrow a point to take, because of the matters which have been mentioned by the right hon. Gentleman and by my hon. Friend the Member for Halifax (Dr. Summerskill) in her eloquent opening of these matters.
Does it help the health of patients to be visited regularly? That is the decision that the Secretary of State must make. If it does, they ought not to have their health impaired because their relatives are less able to afford to visit them regularly than people who have more means.
The matter is becoming more serious not only by reason of inflation, though that is part of the problem, but by the fact that, as a result of the reorganisation of the health service by successive Governments, greater emphasis is being placed on the general district hospital which will take the place of local cottage or smaller hospitals spread about the country. As a result, a great many people now have to travel further to see their relatives in hospital.
I am very conscious of this problem, for the same reason as the right hon. Member for Thirsk and Malton, because there are so many hospitals in my constituency and a large number of them, as the Minister knows, are connected not only with the long-term sick and the geriatric sick but with mental health. The mentally sick pose a particularly distressing problem. I always find it the most distressing part of my work as a Member of Parliament to go around hospitals where there are long-term geriatric cases or long-term mental health cases, who are left almost alone in the world apart from the devoted attention that they get from the staff or, in the rare cases, from the visitors who constantly come to see them, although, often enough, they cannot communicate with their relatives and dear ones.
This problem is accentuated if they belong to a family in which means are limited and long distances have to be travelled. I do not want to put that barrier in their way. However, I agree with the right hon. Gentleman that funds 1293 should not be made available for this purpose if they have to be diverted from hospital building and the provision of facilities inside the hospital. It is not necessary to provide internal accommodation for visitors, which would be very expensive.
It is possible for the Supplementary Benefits Commission to take on this task as part of its overall responsibility and to pay the visitor even though in normal circumstances that person would not be eligible for supplementary benefit. Many families would not qualify for supplementary benefit, sometimes because the breadwinner is in work, but they none the less have very limited means.
Suddenly, at a moment of sickness, which is a crisis situation for most lower-paid families anyway, also to have the burden of paying heavy travelling expenses is a manifest injustice. Manifest injustices go unrequited in our society simply because normally, there are not the means to help, but here it would not normally be a very expensive operation. I drafted my clause so that the Minister would be able to prescribe the limitations under which any expenses would be paid. One would have to show that it was necessary to visit and that one could not afford to make the visit. So the burden could be kept limited, and, since it is a burden that would fall not on the hospital Vote but on the Supplementary Benefits Commission Vote, there is a possibility that the Minister could meet our demands. I know that he could not do it by accepting either of the new clauses; all that we ask of him is that he considers some way in which it could be done before the Bill goes elsewhere.
§ Mr. Nicholas Edwards (Pembroke)
I welcome this debate on a topic that I have raised a number of times at Question Time. I have great sympathy with the object of the clauses. The only question in my mind is whether they are necessary, whether the powers already exist but are not being used. I will listen with interest to what my hon. Friend says about this.
We are, thank goodness, getting away from the old-fashioned and mistaken idea that children get on better in hospital if they are kept well away from their parents. Yet it was pretty dreadful to be reminded, in the interim report of the 1294 Working Party on Children in Hospital in Wales, that visiting at that time was still restricted at half the hospitals in Wales at which children are nursed. The same report showed that there was a grave shortage of mothers-in units in those hospitals.
If that statement appears to be in contradiction to my suggestion that powers may not be necessary, I am certainly encouraged by the fact that since then, in response to a question from me on 3rd May, my right hon. and learned Friend the Secretary of State for Wales has told me that parents are now allowed free access to their children, including the day of operation, in all hospitals in Wales, subject to certain minor restrictions at some hospitals where the responsible consultant considers it necessary not to allow it on clinical grounds.
As for the contruction of units, at the new hospital which is being built in my constituency at Withybush there are to be units for this purpose, so things are at least happening.
None the less, the final report of the working party gives some strong evidence that action is needed very badly. Forty-two per cent. of the respondents said that that there were no overnight facilities at their child's hospital. The report points out that they may well have been right, but that even if they were wrong this is what they believed and they were not disillusioned. The report emphasises the importance of drawing to the attention of parents the facilities that are available. It says that the staff should always ask, as a matter of routine, whether parents want to come in with their children. We are told that 25 of the 87 mothers who stayed in and were the subject of the inquiry had only an armchair. I do not call that an adequate facility.
Turning to the question of cost, the report said:The Working Party wish to draw attention to the fact that a minority (12 per cent.) found the cost of transport very difficult to meet and also that cost and difficulties of transport are unusual in that they vary by social class. Other aspects of having children in hospital, including attitudinal ones, did not vary much by social class. The travel difficulties reflect real differences from one social class to another, of income and wealth, and of access to people who have cars.1295 This is a severe problem in Wales, because of the considerable distances that parents have to travel to hospitals.
The working party observed:there are inadequate public transport facilities available and also inadequate subsidies for the needy.The report went on:The Working Party are concerned…that while the DHSS recommend frequent, preferably daily, visiting of children in hospital, some parents experienced difficulty"—this point was referred to my right hon. Friend the Member for Thirsk and Malton—in receiving sufficient benefit from the DHSS (Supplementary Benefit Section) to travel to visit their child in hospital as often as they wished.The report pointed out that there already seemed to be discrepancies between the various treatments. It drew attention also to the transport subsidy payable in the Highlands and Islands of Scotland and in the Scilly Isles for journeys to hospitals of more than 30 miles, the cost of which, over £1, can be reimbursed without a means test.
In reply to another Parliamentary Question that I put to the Secretary of State for Wales, I received an assurance that this proposal was currently being examined by the Welsh Hospital Board sub-committee on the cost of travelling to hospitals. From that, I understood that the powers presumably already existed. I should like to know whether this is so and whether it is just a question of using existing powers, or whether we may have to have some further provision of the kind suggested in the clauses.
This person has acted with the highest had this valuable report in Wales which I hope will lead to early action. I hope that the deplorable state of affairs that existed previously will quickly be eliminated.
§ Mr. Brynmor John (Pontypridd)
I strongly support the new clauses and am disappointed that the Government's undertaking in Committee on 12th April does not appear to have been fulfilled by positive action. The Minister then undertook to consultto see whether there is anything we can suggest on Report which might meet the Opposition's case "—[OFFICIAL REPORT, Standing Committee G; 12th April, 1973, c. 126.]1296 Certainly, they have not thought that it was worthy of an amendment. However, I hope that the Under-Secretary will meet what he acknowledged and what we all acknowledge to be a very difficult situation.
Two points arise here. There are grave difficulties for those who are dependent upon public transport. That is so whether they live in towns or in the country, because public transport is becoming extremely expensive. It is a comparatively rare luxury. A person dependent upon public transport for taking his child to hospital, or for visiting that child or any other relative in hospital, is in difficulties anyway and is subject to great expense.
The second point is common to town and country, although I acknowledge that it is more apposite to rural areas than to urban areas. This concerns the distance which the patient often has to travel to reach the hospital. We talk of the necessity for the base hospital. Clearly, in thinly populated rural areas this has meant a great divorce in distance from the home, but it has also been caused by the increasing complexity of medicine. Many specialties are now concentrated in particular areas rather than being dispersed. If a person happens to have the sort of disease which needs to be treated at a distant hospital, wherever the parents or other relatives live the patient is almost inaccessible and the journey to visit him is tedious and very costly.
I agree very much with my hon. Friend the Member for York (Mr. Alexander W. Lyon). In our debates we mostly look on illness as being of the shorter kind, with the short hospitalisation, the curative medicine and the discharge within a month or six weeks. But we should be foolish not to recognise that for certain categories of illness there is no cure and it is a matter of visiting year after year. I am thinking particularly of geriatric patients and patients in mental hospitals. It is no accident that both of these categories are the least visited of all patients in our hospitals. People are able without much difficulty to continue visiting over a comparatively short period, or even a couple of months, but to do it week after week or year after year, with no apparent cure or solution in sight, is a great drain upon people's emotional resources, and an even greater drain on 1297 their financial resources. On the matter of fares, therefore, the Under-Secretary ought quickly to answer this problem.
The new clause mentions the provision of accommodation and other facilities. The Under-Secretary has made the valid point that accommodation is not the only problem of those who visit hospitals. I disagree with the right hon. Member for Thirsk and Malton (Sir Robin Turton) when he says that in competing necessities the adaptation of older hospitals to accommodate visitors overnight is not, perhaps, an important priority. I believe that it is. Fortunately, as the newer hospitals are being built this provision for visitors is being incorporated. The older hospitals are still not adapted. There is a great need for that to be done.
I conclude by highlighting the inadequacy of the financial provision for people in this position by raising anonymously the case of a constituent. I have written to the Department about this case at a local level, but I should like the Under-Secretary's views on the situation. My constituent, a child, has a rare and malignant disease. Although she is very young, her mother is dead and her father has deserted her. She has been raised by an aunt. Because of the rarity and malignancy of the disease, she has to travel to London regularly for treatment. She lives in a village which is about seven miles from the nearest railway station, Pontypridd. A ticket is provided from that station to Paddington Station. The hospital is situated not at Paddington Station but some way into London. The aunt has had to give up work to look after this child, who would otherwise be a charge on State funds. How is the aunt supposed to be able to afford not only the bus fare to the railway station at home but the journey to and from the hospital in London and the subsistence she needs in London for herself and the child?
This person has acted with the highest motives in looking after her neice, but she is being penalised heavily because of the inadequacy of the grants being made available by the Department or by the inflexible way this case is being looked at by the officials who have to deal with it.
Part of the trouble that we are tackling tonight is the legal problem of amending the Bill. That is why I commend these provisions. But part of it is a change in the attitude of people who administer 1298 funds which are already available. I hope that the Under-Secretary will have something to say about both facets. The day has long passed when the visitor is regarded as an unnecessary intrusion upon the practice of medicine. The visitor is a necessary ancillary to medical cure and well-being. I hope that the Minister will give a resounding recognition to that fact.
§ Dr. Gerard Vaughan (Reading)
I wish to speak briefly on two points, the first of which follows what was said by the hon. Member for Pontypridd (Mr. John). We are all agreed upon and would support very strongly the value and the need to extend the facilities provided for people to visit not only children and elderly people in hospital but all patients, particularly long-stay patients.
Many facilities are still inadequate, including overnight accommodation, and will take time to implement satisfactorily. But the Under-Secretary can do something now about the point made by the hon. Member for Pontypridd. There is not enough awareness by the staff within hospitals of what facilities are available. It is nurses and doctors on the wards who need to know, for instance, that money is available for travelling, that there are facilities for paying for clothes for children in hospital who are up and about, or that parents who have travelled a long distance should not be sent to an outside restaurant, even if one exists, but should have food provided in the ward. The whole thing could be made easier if a much more positive educational line were taken within the medical, nursing and ancillary professions.
The other point that concerns me very much is that the district hospitals of necessity involve a centralisation, a grouping together of specialist services, but we must be careful not to go too far in this direction. For example, we should not make in our surgical provisions the type of mistake that was made by our predecessors in the last century in the provision of psychiatric care. We do not want huge institutions which are out of touch with patients and the local community, to which people have to travel a long way.
We are now developing a district hospital service in much of the country, but we should also pause to ask whether it is necessary for all the branches of medi- 1299 cine to be at a certain district hospital and whether, having provided the main, central district hospital, we can begin to look much more at small local hospitals which do not need to be so specialised.
§ 8 p.m.
§ Mr. Charles Loughlin (Gloucestershire, West)
No one will suggest that this problem is easy of solution. However, the clauses serve as a basis for the discussion of a problem for which successive Governments have been responsible. A number of Governments have created the atmosphere in which there is now an acceptance that visiting is an essential part of the patient's treatment, not merely the geriatric or the child patient, but virtually every type of patient. We have persuaded hospital authorities, by circular and other means, to extend visiting hours and in many instances to ensure that there is free visiting.
There is also the question of the large district hospital. My constituency has two small cottage hospitals—Dilke and Lydney. I represent a county constituency. The hospitals that many of my constituents use are in Gloucester, which is up to 30 miles from villages from which they draw patients.
It is difficult to make suggestions because, like the right hon. Member for Thirsk and Malton (Sir Robin Turton), I should not like to think that the payment of moneys or the provision of overnight accommodation was likely to impinge upon other priorities in the hospital service. We can only begin this discussion at this stage hoping that the social security provisions can be so manipulated as to ensure that assistance can be given to those who are working but are at present precluded from getting social security benefits.
I recognise the difficulty of visiting relatives in hospital from areas like mine. Gloucester hospitals have two visiting periods per day and also weekend visiting periods. If I had known that I would intervene in this debate I would have taken the trouble to discover the exact fares on a very inadequate rural bus service. Without criticising the bus company I say simply that it is not the type of service that exists in cities or towns because hours may elapse between 1300 services. The return bus fare to Gloucester from Coleford and St. Briavels must be in excess of 60p. Even from places much closer to Gloucester the fare is pretty high.
The Government accept the therapeutic value of visiting. If a mother is denied the opportunity to visit her child every day simply because she cannot afford the fares, we are guilty of a deliberate act of retarding the child's recovery if we do not make some provision for the payment of the costs of visiting.
The wording of new Clause 5 is inadequate. I appreciate that an attempt has been made so to frame the wording as not to impose too great a cost, but the wording could be widened considerably. New Clause 4 would be of terrific advantage.
I ask the Minister to devise permissive provisions in the Bill. He could write in a provision to enable the Minister to make recompense for travelling expenses and overnight stays. This would not commit the Minister to its immediate implementation, but it would enable him to invoke the provision when he was able to get reasonable accommodation from the Department of Health and Social Security under whose aegis the Supplementary Benefits Commission comes.
§ Mr. Roderick
I support the clauses, but I shall confine most of my remarks to new Clause 4.
In Committee hon. Members, almost without exception, referred to their personal experience with children in hospital. That led to a poignant and useful debate, and the Minister must have felt that the case was well put. All of us had had experience of the best practice in assistance with visiting when children are in hospital. We were concerned with the well-being and welfare of the children.
We were all convinced that adequate visiting by parents can assist recovery and overcome a child's fears on entering a large institution such as a hospital. The presence of a parent is of immeasurable value to a child and can be of great assistance to the staff. The parent is of great help in attending to the many needs of the child, whether by providing continuing advice about diet, by washing the child, dressing it, playing with it, or keeping it generally happy and making it 1301 feel that it is not in totally alien surroundings, although obviously the hospital environment will be strange to it.
Travel has become an increasing problem. Centralisation of the services, including the hospital service, has meant that people have to travel greater distances than ever, and this has increased the cost of visiting patients. Last November I asked the Secretary of State for Wales what was the greatest distance a person had to travel in the Principality to visit his nearest district general hospital. The answer was 44 miles. That illustrates the problem that confronts many people. That is a great distance to travel especially if visitors are restricted to half an hour with the patient when they arrive at the hospital. It hardly seems worth while travelling that distance. I know that most hospitals are introducing schemes to allow visitors to stay for longer periods, but those schemes need added momentum. We want the Minister to instruct the hospitals that it is part of their duty to produce such schemes.
There is also the factor of diminishing public transport, which creates problems of accessibility. In these circumstances provision should be made to enable parents to stay at the hospital. It is insufficient simply to provide the money for the fare. In these awkward circumstances there must be facilities for people to stay. In Committee the Minister dwelt almost entirely on the availability of buildings, and complained about the way in which the building programme would be affected by having to provide such facilities. But much can be done without adding any buildings. The clause is necessary to remind the Secretary of State and others of the need. As hon. Members have pointed out, the powers already exist and the clause will therefore provide the necessary pressure for the implementation of what we all seem to want. Let us not regard this as an "either/or" situation—that if we go ahead with this something else will suffer. This is an essential part of the treatment of every patient, and we should consider it in that light.
§ Mr. Elystan Morgan (Cardigan)
The debate has been characterised by a large measure of agreement among hon. Members who have spoken. I am sure that we all hope that when the Minister replies 1302 he will not, albeit in the most dulcet and mellifluous tones, do anything to destroy that agreement. Both clauses have one thing in common. They are designed to improve the lot of the patient by assisting him to maintain the completely necessary contact with the outside world from which he has been separated against his will. New Clause 4 echoes the aspirations and anxieties voiced in the Platt Report of 1959, which examined the welfare of children in hospital. The conclusions of that important study were accepted by the Government of the day. In that year the Ministry of Health went so far as to issue a memorandum to hospitals urging them to implement its provisions as quickly as possible.
The central theme of that report was that children are incomplete, fragile, vulnerable beings and should be treated as such, and not in any way as truncated adults. The report argued that the whole child should be looked after and not just the afflicted limb or organ. One of the strongest recommendations of the report was that everything should be done to avoid the shattering experience suffered by many children because of long separation from their parents. The report summed up the position in these words:When a child is in hospital he is in danger of losing contact with the outside world, which has been up to that time the background of his development. …It is vital that while he is in hospital he should be visited frequently so that he does not feel that hospital life is divorced from everything he knows.Later the report said:We are unanimous in our opinion that the emotional needs of a child in hospital require constant consideration. Changes of environment and separation from familiar people …frequently lead to emotional disturbances which vary in degree and may sometimes last well into adult life.8.15 p.m.
Those words were written over 14 years ago, but it is apparent that we still fall far short of removing many of the evils located by that study. As the hon. Member for Pembroke (Mr. Nicholas Edwards) reminded the House, in Wales we have the benefit of a complete and incisive study, published last year—the Stacey Report on children in hospital in Wales. That report reveals many glaring deficiencies. It shows that there is a complete lack of a comprehensive children's unit in practically 1303 every hospital in Wales. In addition, in many hospitals there is a completely unwholesome situation, where children are kept in adult wards, where there is no screening of children from other patients in casualty departments, and very often no system for allowing the closest contact to be maintained between the child and its parents, and particularly its mother.
In view of the special study that has been made in Wales I am sure that we would all greatly welcome, in this debate or at some other stage, a statement by the Welsh Office about whether it accepts the findings of the report, whether it is intended to implement those recommendations and, if so, whether the Welsh Office will consider, no doubt in concord with the Welsh Hospital Board—which is soon to disappear under the reorganisation—steps for achieving these ends.
§ Mr. Gibson-Watt
It may be convenient for me now to answer the points made by my hon. Friend the Member for Pembroke (Mr. Nicholas Edwards) and the hon. Member for Cardigan (Mr. Elystan Morgan), who was kind enough to advise me that he intended raising this matter. The status of the report is that it was made by Miss Margaret Stacey to the Welsh Hospital Board and not to the Welsh Office. The report is being considered by the board, which will no doubt consider recommendations that it will put to the Welsh Office but which it has not yet done. I do not in any way deny the importance of the report, or of what Labour Members have said about this important side of child care in hospitals in Wales.
§ Mr. Morgan
I am grateful to the Minister of State for that intervention. I appreciate that this report was made to the Welsh Hospital Board, but it is a report of which the Welsh Office is well aware, and it speaks of conditions which are within the direct knowledge of the Welsh Office. Although, therefore, technically speaking it would be discourteous for the Welsh Office to comment on the report until it has received the recommendations of the Welsh Hospital Board, nevertheless, what has been said in this debate will convey strongly to the 1304 Minister of State that action is justified and demanded on the report at the earliest opportunity.
The centrepiece of the new clause is the provision of accommodation for a mother in a hospital where her child is a patient. Ironically, this principle is taken for granted in many primitive and under-developed communities. It seems that it is only in the developed Western world that there has ever been any argument about the necessity for such a system. We appreciate that in the last century, when, in children's wards, doctors were fighting deadly diseases and infection, the highest premium had to be placed on strict order and on asepsis. In those circumstances there was not an appropriate place for parents in the grim atmosphere of the struggle of life or death.
Now, everything seems to have changed with the development of powerful drugs in this century. As far back as 1927 Sir James Spencer established, in the babies' hospital in Newcastle-upon-Tyne, a purpose-built mother-and-child wing. This experiment was followed in scores of western countries, and now there is universal acceptance of the invaluable role of such accommodation, both for the treatment of the child and for the comfort of the mother.
This arrangement also has considerable benefits for the hospitals, for, while the mother cannot take over any part of the nursing role from the medical staff, her action in assisting with the care of her child can enable the medical staff to concentrate their activities on the classical medical role which they were intending to carry out.
No hon. Member would seriously challenge the proposition that this is an extremely important factor in the therapy of the child. We welcome those developments, in addition to the greater liberality with which hospital authorities have in the past five or 10 years viewed the procedures for the visiting of children in hospital. But we want the Minister to state exactly what is the present situation with regard to visiting arrangements and, equally important, to accommodation in hospital for the mother concerned.
Each year 1 million children pass through our hospitals as patients. What percentage were given the opportunity of 1305 having their mothers present for some period of their hospitalisation? The opportunity should be given to every child. It is not sufficient for the facility to be available unless it can be exploited by each parent. As Mr. Justice Darling said, the courts of our country are open to all—but so, he said, is the Ritz Hotel. There is no point in a facility being available for people unless they can avail themselves of it.
For all that has been done by charities, for all the assistance given by hospitals in this matter, many massive gaps remain. This facility must be safeguarded for every parent who wishes to avail himself or herself of it. A parent's lack of financial resources must never result in the parent being deprived of this essential facility. The need of the child, not the financial status of the parent, must come first.
The new clause is not confined to the question of accommodation. It refers to other facilities. I support new Clause 5, in the name of my hon. Friend the Member for York (Mr. Alexander W. Lyon), and have the fullest sympathy for it.
I represent a constituency where from day to day these problems are very acute. Mid-Wales is sparsely populated, and patients, as well as hospital visitors, have to travel distances of 70 to 80 miles. My hon. Friend the Member for Gloucestershire, West (Mr. Loughlin) stated that in his constituency people had to travel 25 to 30 miles to hospitals. That would be regarded as a short distance in my constituency.
The situation has been further bedevilled through the lack of a complete range of specialties in many district hospitals. The question of the provision of a paediatric consultant at Aberystwyth Hospital, in my constituency, has been debated by the Minister of State and myself on many occasions in the House, and I am glad that an appointment is shortly to be made. I hope that the Welsh Hospital Board, no doubt prevailed upon by the Welsh Office, does not impose conditions that would make it difficult for this appointment to be made at an early date. What I have said about the paediatric consultants also applies to the lack of an ear, nose and throat service and of a paediatric wing in the same hospital.
1306 Two-thirds of my constituents are not served by any form of public transport. Add to this the fact that this area of mid-Wales has the lowest income per head of any area in the United Kingdom and we see that there is grave hardship for tens of thousands of people when their children or other members of their family have to enter hospital. Many of my constituents can run cars only by doing without some of the basic necessities of life. The question whether or not a patient in hospital should have visitors involves a basic human right. It is, of course, artificial to have that right as a legal concept if economic factors make it impossible for the right to be exercised. We maintain that only by tackling the problem in a bold and imaginative way can such a fundamental right be safeguarded.
The general principle has already been conceded by successive Governments. The hon. Member for Pembroke (Mr. Nicholas Edwards) has already referred to the concessions which are allowed to patients visiting hospitals in the Scilly Isles and the Highlands and Islands of Scotland. That facility does not extend to visitors. A few limited provisions are to be found in the Ministry of Social Security Act 1966, the Children and Young Persons Act 1963, the Public Health Act 1968 and in the National Health Service regulations made in 1950 regarding expenses in attending hospitals. There is no general provision for visitors save the discretion vested in the authorities under Section 2 of the Ministry of Social Security Act 1966.
If the needs that have so clearly been shown during the debate are to be met there must be new and comprehensive legislation to deal specifically with the problem. The fragmented legal powers that now exist are inadequate. No hon. Member would ever support the proposition that a child should remain in hospital without regular visits by its parents, or that a person who has been extremely ill, with the flame of life flickering low, should be deprived of visitors.
Nevertheless, in the circumstances in which we live, unless we are willing to pass these two new clauses we shall deny basic human rights to tens of thousands of people in Great Britain. It is for 1307 those reasons that I commend both new clauses to the House.
§ Mr. Alison
There have been three strands to this warm-hearted and humane debate about the provision of the needs of children in hospital: first, the question of accommodation; second, the payment of travelling expenses for parents visiting children; and third, the rather wider new Clause 5, in the name of the hon. Member for York (Mr. Alexander W. Lyon), which refers to the provision of travelling expenses of relatives and not necessarily relatives of children in hospital.
On the first strand, the broad question of accommodation and parallel facilities for those parents who visit their children in hospital, I owe the House, as the hon. Member for Pontypridd (Mr. John) reminded the House, an explanation for not bringing forward a specific amendment as I did in Committee The explanation is simple. Hon. Members will recall that I reminded the Committee that we already make substantial and active provision for patients' relatives by way of accommodation and other facilities. The issue is whether we should make explicit in the Bill in some shape or form the provision which we are already making.
The only place in which we could have done so was in the context of Clause 2—namely, the Secretary of State's general obligation to provide throughout England and Wales, to such extent as he considers necessary to meet all reasonable requirements, hospital accommodation and various other services. We thought on reflection that it would be unnecessary and probably undesirable to make explicit that the Secretary of State's duty under the clause to meet all reasonable requirements for hospital accommodation extends to accommodation for visitors.
That duty covers a vast and complex range of facilities. It would be impracticable to spell them all out in the Bill and wrong to single out provision for visitors for explicit mention rather than the necessity of providing, for example, operating theatres or X-ray facilities. It seems that the appropriate place to state what is necessary is in building notes and other policy guidance and letters to hospital boards. That is the best way of doing it.
1308 It is in that context that we have sought to do a great deal. I add in parenthesis, although I see that my hon. Friend the Member for Reading (Dr. Vaughan) is not in the Chamber, that the publicising of what we already encourage hospitals to do and what many hospitals can do is an important point. I think that we shall get more publicity through the sort of communication with hospital authorities to which I have referred than by trying to put the clause in the Bill. There will he less awareness of what is possible and desirable by including the clause in the Bill than through the measures which I have taken already.
It has been the policy of successive Ministers that parents should be encouraged to visit and stay overnight where necessary. Since the Platt Report of 1959, the matter has been publicised in no fewer than four hospital memoranda—in 1959 and again in 1966, 1971 and 1972. The hon. Member for Gloucestershire, West (Mr. Loughlin) will recall some of these hospital memoranda because he was associated with them.
Then again, the existing building guidance recommends a proportion of single rooms as being desirable for new hospitals and suitable for a mother and child as part of the children's ward accommodation, and the provision of waiting and interview rooms for parents and relatives generally—not only the parents of children. A circular letter which we sent out last year to hospital authorities asked them to review the facilities available for parents taking meals in hospital. This is an instance of the sort of care and need we have in mind—the use of staff dining rooms, the provision of separate places for parents to eat food brought in, and the use of vending machines. All these things, we have reminded hospitals, have to be looked at in the context of the needs of visiting relatives or parents.
The 1972 letter to the hospital authorities said that, where the hospital considered the parents' presence necessary for the child's wellbeing, meals and accommodation should be free. I again underline that it is common policy on both sides of the House that it is essential for everything to be done to humanise and familiarise the hospital environment from the point of view of the child in the 1309 interests of his speedy recovery. This means making it as home-like as possible in the context of the children's unit, and, above all, that parents or other close relatives should be encouraged to take part in the whole process of recovery, being there as much as possible and, if necessary, living there.
Since we are still not satisfied, however, that everything possible has been done. the working party between my Department and the British Paediatric Association, which is considering, again in the broad, the question of hospital accommodation for children, will specifically include in its consideration the whole aspect of accommodation and the participation of parents in the hospital process. So we have issued a lot of guidance and will continue to do so, and we have particular needs under review. So much for the question of accommodation. We believe that there is no need for an amendment to the Bill, or indeed, for an attempt to publicise what it would amount to, because the powers of action are already there.
§ Mr. Elystan Morgan
While accepting that the Department is fully convinced of the need for such accommodation facilities in every hospital, and that the circulars have been sent out, presumably with some record kept of what reaction there is, may I ask the hon. Gentleman whether he is able to give a target date by which these facilities will be provided by every hospital in the land?
§ Mr. Alison
I could not give either a target date or the sort of figures for which the hon. Gentleman asked earlier on the question of participation by parents in the millions of stays which children make in hospital. It would impose an onerous duty on the staff of hospital authorities to ask them for further statistics.
On the question of ideal provision for parents, we are still, in the context of the working party, trying to determine what is the ideal. It would be wrong to specify and oversimplify. Such a target might well have to be reconsidered later.
The two other strands in the debate are the question of support for cost of travelling of parents particularly and of other relatives visiting people in hospital. I listened carefully to the hon. Member 1310 for Pontypridd, who presented a moving personal constituency case. Without being able to go into the matter carefully, it struck me that it should have been possible under existing legislation for the child who had to visit the hospital to receive all necessary financial support for the travel to and fro. These aspects come into the ambit of support provision. I shall examine carefully what the hon. Gentleman said and why the escort in this case was not susceptible of support for travelling expenses. Facilities are available for escorts to be subsidised where the need is pressing. I will look into the case and, if necessary, ask the hon. Gentleman to provide me with further details.
The ideal on this question of travelling expenses for parents visiting children in hospital is, I suppose, that postulated by the National Association for the Welfare of Children in Hospital. The association's aim, with which I believe the Opposition identify themselves, is that there should be no discrimination and that financial assistance should be made available to parents visiting children in hospital irrespective of their means. That is where we come to a great difficulty in the matter of financial and other resources. The association's scheme would cost at least £2 million simply in respect of parents visiting children and it would cost a great deal more under the proposal made by the hon. Member for York. To spend £2 million indiscriminately for parents, including well-to-do parents, in this way is something we should not consider.
We have to remember that at the margin we are having to cut off expenditure on provision vital in terms of health. Two million pounds would be enough to enable us to increase by over half the invalid services, or it could give us 10 operating theatre suites. Is it right that we should spend £2 million in indiscriminate help when many of those concerned are well able to afford the cost themselves? I grant that some cannot find it, but for them we make provision in the Supplementary Benefits Scheme to see that they get support and financial help. That acts as a safety net for those in real need.
I agree with the hon. Member for Gloucestershire, West that it excludes those who are in full-time employment, 1311 but the House must recall that here we are considering the financial contingency for a family who have passed into the care of a hospital a dependent member of the family for whom the hospital will provide not only medical care and attention but also lodging. So there is an offset to the financial problems faced by the family in so far as it is relieved of some of the expenditure normally arising in the context particularly of a child.
Here I come to the point made by my right hon. Friend the Member for Thirsk and Malton (Sir Robin Turton), the reference to a 12 weeks' wait before payment was available under the Supplementary Benefits Scheme. I think it arises under the context in which the scale rate payable for a dependent child who goes into hospital is left unchanged for 12 weeks. That is to say, the payment is made in respect of that dependent child as if he or she were living at home and all board and lodging were catered for in the hospital and treated as if the child were still at home. Only after that is a reduction made in the scale rate payments for the child, but it is a reduction very much less than the cost which the hospital has taken on in supporting the child.
§ Sir Robin Turton
This is the wrong way of looking at it. The Supplementary Benefits Commission should look at the expenses which the parent in need cannot afford in visiting the child in hospital. It is equally important for the parent to visit the child in the first four weeks in hospital as it is in the 20th or 30th week; in fact rather more important. I hope my hon. Friend will ask the other side of his Department to look at this.
§ 8.45 p.m.
§ Mr. Alison
I can further reassure my right hon. Friend. The general proposition is that because there is no reduction in the scale rate there is a net increase in the financial resources available to the average supplementary benefit family which has lost a dependant to the hospital. If, even in this context, there is hardship and difficulty involved the 12-week rule can be broken and supplementary benefit can be paid earlier.
§ Dr. Summerskill
Would the hon. Gentleman not agree that to quote the 1312 estimate of the national association, which took an overall amount, as being "indiscriminate payment to any parent" who wants to visit is rather unfair because it is clearly laid out in the terms of the new clause that it is for the Secretary of State to make regulations coveringthe nature, mode and scale of such facilities"?We are not proposing such a wide scheme as the national association. Have not the Government, before they came to this debate, made their own plans about what might be a system of remuneration? Certainly it would not be an overall one. There would clearly have to be some kind of means test.
§ Mr. Alison
If the hon. Lady is saying that her party does not go the whole way with the national association's scheme for indiscriminate payments she is in terms saying that she believes in some sort of discrimination, which is what happens at present. We discriminate in respect of those who are on supplementary benefit and are self-evidently needy. We do not make provision for those not on supplementary benefit who can clearly meet the modest amount out of their own pockets.
The clause is a little vague. It does not talk in the context of financial assistance about travelling expenses. It goes very much wider. We are not talking about financial assistance simply for travelling expenses. The phrase is used in the context of:other facilities, including financial assistancewhich may be much wider. This is one of the reasons why we could not make an open-ended commitment of this character.
§ Mr. Cledwyn Hughes (Anglesey)
The hon. Gentleman is not dealing with the point put by my hon. Friends; namely, the large category of people outside those in receipt of supplementary benefit and who might have to travel considerable distances of 70 miles or more. In my area it is possible that for certain specialties parents may have to travel 100 miles to Liverpool or to the Wirral. What does he have to say to this? People in low income groups cannot afford even weekly visits over such long distances. The hon. Gentleman is making a sympathetic speech but is falling down on this point.
§ Mr. Alison
The right hon. Gentleman has singled out the admittedly grey area about which it is extremely difficult to be specific in terms of real need; that is, those who may be hard-pressed financially but are above the supplementary scale rates or are in full-time employment but cannot afford this kind of expense. There may be real and substantial cases here. As I have said, the supplementary benefits scheme can still pick them up if there is a real and emergency need.
I concede that there is a real problem for those who are hard-pressed. It is one which the hon. Member for York has attempted to meet. It is in this context that I should address myself to his clause. He has taken the point that it is reasonable to make discrimination in respect of need. He has also taken the point made by his right hon. Friend the Member for Anglesey (Mr. Cledwyn Hughes), that need goes rather wider than the supplementary benefit scale rates and extends to those who are hard pressed.
§ Mr. Loughlin
The hon. Gentleman has attempted to reply to a point I made. I want clarification of it because it is essential that this should be broadcast if what he is saying is true. Can he tell us what are the emergencies to which he refers when he says that a visit to a patient can be assisted through supplementary benefit, even though a person is working?
§ Mr. Alison
The best thing I can do is to refer the hon. Gentleman to the memorandum which we have circulated. I will send hon. Members a copy so that he can read the terms. It is the "Travelling expenses and transport for hospital patients and visitors" memorandum of May 1973. I am turning rapidly through it. I think the relevant columns are 31 and 32. I will send the hon. Member a copy and he can read the document in full. It is published and is widely known and available in the hospital world.
I come to the attempt by the hon. Member for York further to refine selectivity, discrimination, in respect of need. He uses telling phrases, selection "in accordance with needs", "in accordance with the gravity of the illness", "in accordance with the notion of reasonableness". He is attempting to carry these discriminating factors forward into this 1314 grey area beyond the rather crude but simple limits imposed by the Supplementary Benefits Commission—to the grey area where people's needs are above the supplementary benefit level but are still indeterminate, and where people may he hard pressed. He is attempting to define the instrument of selectivity here. This is the difficulty we find when we try to do this. He is imposing upon hospital authorities-not the Supplementary Benefits Commission, because the Supplementary Benefits Commission is, as it were, under stated statutory limitations and cannot help in this particular dimension—the duty of making the sort of assessment of real needs based upon reasonableness, gravity of the illness, and means of the patient, which would enable special payments to be made over and above the group helped by the supplementary benefits.
This would place an impossible load of additional demands upon medical or ward staff, and it would be quite disproportionate to the sort of help which might emerge at the end, unless a complex administrative system were established in hospitals to record visits, to determine the need to visit in relation to the gravity of the illness, to investigate the means of visitors. Such a scheme would be wide open to abuse. The system necessary to check claims for travelling expenses would place heavy demands on hospital staff who are not equipped to investigate means of visitors, and local social security staff, who, goodness knows, are hard pressed enough at the present time, might have to be called in.
Determination of those cases considered to be grave enough by the hospital authorities to warrant the payment of expenses would inevitably involve hospital staff in making discretionary judgments which would be a source of discord between patients and their visitors and the staff responsible. We think that this attempt to break up the crude levels postulated by supplementary benefits would put a heavy burden upon the hospital administration and might be a source of ill will among people who fell upon the wrong side of the line of the determination, and also among patients and visitors and the hospital staffs. Therefore, on its own terms, the clause is unacceptable.
§ Mr. Alexander W. Lyon
The Under-Secretary is making rather heavy weather of a very simple clause. All I am asking is that the Secretary of State should prepare a scheme. Who administers it will lie within the power of the Secretary of State to determine under regulations. Already almoners do something of this nature in an ad hoc way. All I am asking for is a scheme to be prescribed by regulations—to be administered by almoners, since they already do it. They would then be able to make the kind of decisions they make at the moment, but upon a statutory basis instead of an ad hoc basis. They already discriminate. Why should they not discriminate upon a statutory principle? This is what I am asking.
§ Mr. Elystan Morgan
Since 1964 in two parts of the United Kingdom, in the Scilly Isles and in the seven crofting counties of Scotland, a scheme which is not based on any means test at all has been implemented. That scheme is run by the hospitals themselves.
§ Mr. Alison
I need notice of the reference which the hon. Gentleman made to the Isles of Scilly. He appears to have direct knowledge of this area. I will follow up what he has said about the Isles of Scilly and consider it.
The hon. Member for York is not facing the problem of putting into statutory form this statutory and, therefore, universal national requirement for hospitals to look into every case in which the relative of a patient in hospital who is above the supplementary benefits level could still call upon the hospital to assess the reasonableness of the cost of the visit, the lack of means and the gravity of the illness of the patient in hospital. The hospital would be bound to do this—either the almoner or the hospital administrative staff. The staff would quickly get gummed up and, instead of
§ being concerned, as it properly should be, with the health of the patient, would be concerned with a dispute—probably an angry one—with relatives who are arguing about how much they can afford to pay to come to see the patient.
§ The scope for voluntary help must not be overlooked. Voluntary help can play an effective rôle here, particularly in organising voluntary transport services which in needy cases can help both the physical and financial strain. We are concerned about not only the financial strain but the distance, the time consumed and the energy used in visiting.
§ After consultation with a number of voluntary organisations, a circular to hospital authorities on this subject was issued last month. It included the suggestion that the running expenses of a voluntary transport system might be a worthwhile objective for the fund-raising activities of hundreds of leagues of friends and similar bodies which are active throughout the country.
§ I believe that the Opposition have conceded in their speeches the essential point about which we are concerned, that in travelling expenses discrimination must be made in respect of need. This is already done through the Supplementary Benefits Commission and we should not put further assessing rôles and duties on the hospital administrative staff.
§ In the matter of accommodation we are all square. A lot has been done. More could be done, and we are proposing to have it done. The clause is redundant and, in so far as it is vague about financial commitments, undesirable. I ask the House to reject it.
§ Question put, That the clause be read a Second time: ——
§ The House divided: Ayes 246, Noes 272.1319
|Division No. 149.]||AYES||[9.00 p.m.|
|Abse, Leo||Bennett, James( Glasgow, Bridgeton)||Buchanan, Richard (G'gow, Sp'burn)|
|Allaun, Frank (Salford, E.)||Bidwell, Sydney||Butler, Mrs. Joyce (Wood Green)|
|Archer, Peter (Rowley Regis)||Bishop, E. S.||Campbell, I. (Dunbartonshire, W.)|
|Armstrong, Ernest||Blenkinsop, Arthur||Cant, R. B.|
|Ashley, Jack||Boardman, H. (Leigh)||Carmichael, Neil|
|Ashton, Joe||Booth, Albert||Carter, Ray (Birmingh'm, Northfield)|
|Atkinson, Norman||Boothroyd, Miss B. (West Brom.)||Castle, Rt. Hn. Barbara|
|Bagier, Gordon A. T.||Bottomley, Rt. Hn. Arthur||Clark, David (Colne Valley)|
|Barnes, Michael||Boyden, James(Bishop Auckland)||Cocks, Michael (Bristol, S.)|
|Barnett, Joel (Heywood and Royton)||Broughton, Sir Alfred||Cohen, Stanley|
|Baxter, William||Brown, Hugh D. (G'gow, Provan)||Coleman, Donald|
|Beaney, Alan||Buchan, Norman||Concannon, J. D.|
|Corbet, Mrs. Freda||Janner, Greville||Parker, John (Dagenham)|
|Cox, Thomas (Wandsworth, C.)||Jay, Rt. Hn. Douglas||Parry, Robert (Liverpool, Exchange)|
|Crawshaw, Richard||Jeger, Mrs. Lena||Pavitt, Laurie|
|Cronin, John||Jenkins, Hugh (Putney)||Peart, Rt. Hn. Fred|
|Crosland, Rt. Hn. Anthony||John, Brynmor||Perry, Ernest G.|
|Crossman, Rt. Hn. Richard||Johnson, Carol (Lewisham, S.)||Prentice, Rt. Hn. Reg.|
|Cunningham, Dr. J. A. (Whitehaven)||Johnson, James (K'ston-on-Hull, W.)||Prescott, John|
|Dalyell, Tam||Johnson, Walter (Derby, S.)||Price, William (Rugby)|
|Davidson, Arthur||Jones, Barry (Flint, E.)||Probert, Arthur|
|Davies, Denzil (Llanelly)||Jones, Dan (Burniey)||Radice, Giles|
|Davies, G. Elfed (Rhondda, E.)||Jones, Gwynoro (Carmarthen)||Rankin, John|
|Davies, Ilfor (Gower)||Jones, T. Alec (Rhondda, W.)||Reed, D. (Sedgefield)|
|Davis, Clinton (Hackney, C.)||Kaufman, Gerald||Rees, Merlyn (Leeds, S.)|
|Davis, Terry (Bromsgrove)||Kelley, Richard||Rhodes, Geoffrey|
|Deakins, Eric||Kinnock, Neil||Roberts, Albert (Normanton)|
|de Freitas, Rt. Hn. Sir Geoffrey||Lambie, David||Roberts, Rt.Hn.Goronwy (Caernarvon)|
|Delargy, Hugh||Lamborn, Harry||Robertson, John (Paisley)|
|Dell, Rt. Hn. Edmund||Lamond, James||Roderick, Caerwyn E.(Brc'n&R'dnor)|
|Dempsey, James||Latham, Arthur||Roper, John|
|Doig, Peter||Lawson, George||Rose, Paul B.|
|Dormand, J. D.||Lee, Rt. Hn. Frederick||Ross, Rt. Hn. William (Kilmarnock)|
|Douglas, Dick (Stirlingshire, E.)||Leonard, Dick||Rowlands, Ted|
|Douglas-Mann, Bruce||Lewis, Arthur (W. Ham, N.)||Sandelson, Neville|
|Driberg, Tom||Lewis, Ron (Carlisle)||Sheldon, Robert (Ashton-under-Lyne)|
|Duffy, A. E. P.||Lipton, Marcus||Shore, Rt. Hn. Peter (Stepney)|
|Dunn, James A.||Lomas, Kenneth||Short, Mrs. Renée (W'hampton, N.E.)|
|Dunnett, Jack||Loughlin, Charles||Silkin, Rt. Hn. John (Deptford)|
|Edelman, Maurice||Lyon, Alexander W. (York)||Silkin, Hn. S. C. (Dulwich)|
|Edwards, Robert (Bilston)||Lyons, Edward (Bradford, E.)||Sillars, James|
|Edwards, William (Merioneth)||McBride, Neil||Silverman, Julius|
|Ellis, Tom||McCartney, Hugh||Skinner, Dennis|
|English, Michael||McElhone, Frank||Small, William|
|Evans, Fred||McGuire, Michael||Smith, John (Lanarkshire, N.)|
|Ewing, Harry||Machin, George||Spearing, Nigel|
|Fernyhough, Rt. Hn. E.||Mackenzie, Gregor||Spriggs, Leslie|
|Fisher, Mrs. Doris (B'ham, Ladywood)||Mackie, John||Stallard, A. W.|
|Fletcher, Raymond (Ilkeston)||Mackintosh, John P.||Steel, David|
|Fletcher, Ted (Darlington)||Stewart, Rt. Hn. Michael (Fulham)|
|Foot, Michael||McMillan, Tom (Glasgow, C.)||Stoddart, David (Swindon)|
|Ford, Ben||McNamara, J. Kevin||Stonehouse, Rt. Hn. John|
|Forrester, John||Mahon, Simon Bootle||Strauss, Rt. Hn. G. R.|
|Mallalieu, J. P. W. (Huddersfield, E.)||Summerskill, Hn. Dr. Shirley|
|Fraser, John (Norwood)|
|Freeson, Reginald||Marquand, David Marsdon, F.||Swain, Thomas|
|Marsden, F.||Thomas, Rt.Hn.George (Cardiff, W.)|
|Galpern, Sir Myer||Mason, Rt. Hn. Roy||Thomas, Jeffrey (Abertilltery)|
|Garrett, W. E.||Mayhew, Christopher||Tinn, James|
|Gilbert, Dr. John||Meacher, Michael||Tomney, Frank|
|Ginsburg, David (Dewsbury)||Mellish, Rt. Hn. Robert||Tope, Graham|
|Gordon Walker, Rt. Hn. P. C||Mendolson, John||Torney, Tom|
|Gourlay, Harry||Mikardo, Ian||Tuck, Raphael|
|Grant, George (Morpeth)||Millan, Bruce||Urwin, T. W.|
|Grant, John D. (Islington, E.)||Millar Dr. M. S.||Varley, Eric G.|
|Griffiths, Eddie (Brightside)||Milne, Edward||Wainwright, Edwin|
|Hamilton, James (Bothwell)||Mitchell, R. C. (S'hampton, Itchen)||Walden, Brian (B'm'ham, All Saints)|
|Hamilton, William (Fife, W.)||Molloy, William||Walker, Harold (Doncaster)|
|Hamling, William||Morgan, Elystan (Cardiganshire)||Wallace, George|
|Hannan, William (G'gow, Maryhill)||Morris, Alfred (Wythenshawe)||Watkins, David|
|Hardy, Peter||Morris, Charles R. (Openshawe)||Weitzman, David|
|Harrison, Walter (Wakefield)||Morris, Rt. Hn. John (Aberavon)||Wellbeloved, James|
|Hart, Rt. Hn. Judith||Murray, Ronald King||Wells, William (Walsall. N.)|
|Hattersley, Roy||Oakes, Gordon||White, James (Glasgow, Pollok)|
|Healey, Rt. Hn. Denis||Ogden, Eric||Whitehead, Phillip|
|Heffer, Eric S.||O'Halloran, Michael||Whitlock, William|
|Horam, John||O'Malley, Brian||Williams, Alan (Swansea, W.)|
|Houghton, Rt. Hn. Douglas||Oram, Bert||Williams, Mrs. Shirley (Hitchin)|
|Howell, Denis (Small Heath)||Orbach, Maurice||Williams W T (Warrington)|
|Huckfield, Leslie||Orme, Stanley||Woof, Robert|
|Hughes, Rt. Hn. Cledwyn (Anglesey)||Oswald, Thomas|
|Hughes, Mark (Durham)||Padley, Walter||TELLERS FOR THE AYES:|
|Hughes, Robert (Aberdeen, N.)||Paget, R. T.||Mr. John Golding and Mr. Joseph Harper.|
|Hughes, Roy (Newport)||Palmer, Arthur|
|Irvine. Rt. Hn. Sir Arthur (Edge Hill)||Pannell, Rt. Hn. Charles|
|Adley, Robert||Balniel, Rt. Hn. Lord||Boardman, Tom (Leicester, S.W.)|
|Alison, Michael (Barkston Ash)||Batsford, Brian||Body, Richard|
|Allason, James (Hemel Hempstead)||Beamish, Col. Sir Tufton||Boscawen, Hn. Robert|
|Amery, Rt. Hn. Julian||Bell, Ronald||Bowden, Andrew|
|Archer, Jeffrey (Louth)||Bennett, Sir Frederick (Torquay)||Braine, Sir Bernard|
|Astor, John||Bennett, Dr. Reginald (Gosport)||Bray, Ronald|
|Atkins, Humphrey||Benyon, W.||Brown, Sir Edward (Bath)|
|Awdry, Daniel||Berry, Hn. Anthony||Bruce-Gardyne, J.|
|Baker, Kenneth (St. Marylebone)||Biffen, John||Bryan, Sir Paul|
|Baker, W. H. K. (Banff)||Biggs-Davison, John||Buchanan-Smith, Alick ( Angus, N&M)|
|Buck, Antony||Higgins, Terence L.||Proudfoot, Wilfred|
|Builus, Sir Eric||Hiley, Joseph||Pym, Rt. Hn. Francis|
|Burden, F. A.||Hill, John E. B. (Norfolk, S.)||Quennell, Miss J. M.|
|Butler, Adam (Bosworth)||Hill, James (Southampton, Test)||Raison, Timothy|
|Campbell, Rt. Hn. G. (Moray & Nairn)||Holland, Philip||Ramsden, Rt. Hn. James|
|Carlisle, Mark||Holt, Miss Mary||Rawlinson, Rt. Hn. Sir Peter|
|Carr, Rt. Hn. Robert||Hordern, Peter||Redmond, Robert|
|Channon, Paul||Hornby, Richard||Reed, Laurance (Bolton, E.)|
|Chapman, Sydney||Hornsby-Smith,Rt.Hn.Dame Patricia||Rees, Peter (Dover)|
|Chichester-Clark, R||Howell, David (Guildford)||Rees-Davies, W. R.|
|Churchill, W. S.||Howell, Ralph (Norfolk, N.)||Renton, Rt. Hn. Sir David|
|Clark, William (Surrey, E.)||Hunt, John||Rhys Williams, Sir Brandon|
|Clarke, Kenneth (Rushcliffe)||Hutchison, Michael Clark||Ridley, Hn. Nicholas|
|Clegg, Walter||Iremonger, T. L.||Rippon, Rt. Hn. Geoffrey|
|Cockeram, Eric||Irvine, Bryant Godman (Rye)||Roberts, Wyn (Conway)|
|Cooke, Robert||James, David||Rodgers, Sir John (Sevenoaks)|
|Coombs, Derek||Jenkin, Patrick (Woodford)||Rost, Peter|
|Cooper, A. E.||Jessel, Toby||Royle, Anthony|
|Cordle, John||Johnson Smith, G. (E. Grinstead)||Russell, Sir Ronald|
|Corfield, Rt. Hn. Sir Frederick||Jones, Arthur (Northants, S.)||Scott, Nicholas|
|Cormack, Patrick||Jopling, Michael||Scott-Hopkins, James|
|Costain, A. P.||Joseph, Rt. Hn. Sir Keith||Shaw, Michael (Sc'b'gh & Whitby)|
|Critchley, Julian||Kaberry, Sir Donald||Shelton, William (Clapham)|
|Crouch, David||Kellett-Bowman, Mrs. Elaine||Shersby, Michael|
|Crowder, F. P.||Kimball, Marcus||Simeons, Charles|
|Dalkeith, Earl of||King, Evelyn (Dorset, S.)||Sinclair, Sir George|
|d'Avigdor-Goldsmid, Sir Henry||Kirk, Peter||Skeet, T. H. H.|
|d'Avigdor-Goldsmid.Maj.-Gen.Jack||Kitson, Timothy||Smith, Dudley (W'wick & L'mington)|
|Dean, Paul||Knight, Mrs. Jill||Soref, Harold|
|Digby, Simon Wingfield||Knox, David||Speed, Keith|
|Dixon, Piers||Lamont, Norman||Spence, John|
|Dodds-Parker, Douglas||Lane, David||Sproat, Iain|
|Drayson, G. B.||Langtord-Holt, Sir John||Stainton, Keith|
|du Cann, Rt. Hn. Edward||Le Marchant, Spencer||Stanbrook, Ivor|
|Dykes, Hugh||Lewis, Kenneth (Rutland)||Stewart-Smith, Geoffrey (Belper)|
|Eden, Rt. Hn. Sir John||Lloyd, Ian (P'tsm'th, Langstone)||Stodart, Anthony (Edinburgh, W.)|
|Edwards, Nicholas (Pembroke)||Loveridge, John||Stokes, John|
|Elliot, Capt. Walter (Carshalton)||McAdden, Sir Stephen||Stuttaford Dr. Tom|
|Elliott, R. W. (N'c'tle-upon-Tyne,N.)||MacArthur, Ian||Sutcliffe, John|
|Emery, Peter||McCrindle, R. A.||Tapsell, Peter|
|Eyre, Reginald||McLaren, Martin||Taylor, Sir Charles (Eastbourne)|
|Farr, John||Maclean, Sir Fitzroy||Taylor,Edward M.(G'gow,Cathcart)|
|Fenner, Mrs. Peggy||McMaster, Stanley||Taylor, Frank (Moss Side)|
|Fidler, Michael||Macmillan,Rt.Hn.Maurice(Farnham)||Taylor, Robert (Croydon, N. W.)|
|Finsberg, Geoffrey (Hampstead)||McNair-Wilson, Michael||Tebbit, Norman|
|Fisher, Nigel (Surbiton)||McNair-Wilson, Patrick (New Forest)||Temple, Jchn M.|
|Fookes, Miss Janet||Maddan, Martin||Thatcher, Rt. Hn. Mrs. Margaret|
|Fortescue, Tim||Model, David||Thomas, John Stradling (Monmouth)|
|Foster, Sir John||Marples, Rt. Hn. Ernest||Thomas, Rt. Hn. Peter (Hendon, S.)|
|Fowler, Norman||Marten, Neil||Thompson, Sir Richard (Croydon, S.)|
|Fraser,Rt.Hn.Hugh(St'fford & Stone)||Mather Carol||Tilney, John|
|Galbraith, Hn. T. G. D.||Maude, Angus||Trafford, Dr. Anthony|
|Gardner. Edward||Maudling, Rt. Hn. Reginald||Trew, Peter|
|Gibson-Watt, David||Mawby, Ray||Tugendhat, Christopher|
|Gilmour, Ian (Norfolk, C.)||Maxwell-Hyslop, R. J.||Turton, Rt. Hn. Sir Robin|
|Glyn, Dr. Alan||Meyer, Sir Anthony||van Straubenzee, W. R.|
|Godber, Rt. Hn. J. B.||Mills Peter (Torrington)||Vaughan, Dr. Gerard|
|Goodhart, Philip||Miscampbell, Norman||Vickers, Dame Joan|
|Gorst, John||Mitchell, David (Basingstoke)||Waddington, David|
|Gower, Raymond||Moate, Roger||Walder, David (Clitheroe)|
|Grant, Anthony (Harrow, C.)||Money, Ernie||Walker-Smith, Rt. Hn. Sir Derek|
|Gray, Hamish||Monks, Mrs. Connie||Wall, Patrick|
|Green, Alan||Monro, Hector||Walters, Dennis|
|Grieve, Percy||More, Jasper||Ward, Dame Irene|
|Griffiths, Eldon (Bury St. Edmunds)||Morgan-Giles, Rear-Adm.||Warren, Kenneth|
|Gryils, Michael||Mudd, David||Weatherill, Bernard|
|Gummer, J. Selwyn||Murton, Oscar||Wells, John (Maidstone)|
|Gurden, Harold||Nabarro, Sir Gerald||Wiggin, Jerry|
|Hall, Miss Joan (Keighley)||Neave, Airey||Wilkinson, John|
|Hall, John (Wycombe)||Nicholls, Sir Harmar||Winterton, Nicholas|
|Hall-Davis, A. G. F.||Noble, Rt. Hn. Michael||Wolrige-Gordon, Patrick|
|Normanton, Tom||Wood, Rt. Hn. Richard|
|Hamilton, Michael (Salisbury)||Onslow, Cranley||Woodhouse, Hn. Christopher|
|Hannam, John (Exeter)||Oppenheim, Mrs. Sally||Woodnutt, Mark|
|Harrison, Brian (Maldon)||Orr, Capt. L. P. S.||Worsley, Marcus|
|Harrison, Col. Sir Harwood (Eye)||Page, Rt. Hn. Graham (Crosby)||Wylie, Rt. Hn. N. R.|
|Haselhurst, Alan||Parkinson, Cecil||Younger, Hn. George|
|Hastings, Stephen||Percival, Ian|
|Havers, Michael||Pike, Miss Mervyn||TELLERS FOR THE NOES:|
|Hawkins, Paul||Pink, R. Bonner||Mr. Hugh Rossi and Mr. Marcus Fox.|
|Hay, John||Pounder, Rafton|
|Heseltine, Michael||Powoll, Rt. Hn. J. Enoch|
|Hicks, Robert||Price, David (Eastleigh)|
§ Question accordingly negatived.