§ Order for Second Reading read.
§ 2.30 p.m.
§ Mr. Alexander W. Lyon (York)
I beg to move, That the Bill be now read a Second time.
This Bill was conceived originally in deep, cold anger, which has now come to boiling point, because it is clear that an issue of immense importance to 8 million pensioners, at least a ½ million of whom are at risk as to life and health by the absence of proper heating in their homes, is to be frustrated by the way in which the previous Bill was dealt with. That was, no doubt, a perfectly proper Bill to bring before the House. I heard what was said in the closing speeches and I accept what was said then, but to use the device of taking that Bill in Committee on the Floor of the House at such length in order to stop proper discussion of a Bill which would provide adequate heating allowances for elderly people seems to me to be a complete negation of what this House is about.
§ Mr. Iain Sproat (Aberdeen, South) rose—
§ Mr. Lyon
No, I will not give way. The hon. Member took 41 minutes in 1708 speaking to Clause 1 of his own Bill and I certainly do not intend to give way to him now.
This Bill is concerned with a major social problem of our time. If we are concerned about poverty we are concerned to a very large extent about the fate of elderly people in our society. It is a disgrace, in the conditions of modern Britain, where our gross national product is some £53,000 million and when we can and we should afford to make proper provision for the welfare of our old people, that we have signally failed to do that, to the extent that people die of cold in the Britain of 1973. I will come to the figures in a few moments, but the Ministry keeps on repeating the figures in the Registrar-General's return that on average 100 people a year die of hypothermia and are classified as old people.
If that were all, it would be a scandal, and it ill betides any Government, whether of blue or red complexion, to accept that complacently, as though all that is denoted by this is the problem of heating for the elderly. For us to sit here complacently to consider 100 old people a year dying because they are cold, when we should provide means which would enable them to continue to live, seems to me a gross indictment of our society.
In fact the situation is very much worse than that. All the researches which have been done into this problem suggest that the Registrar-General's return merely indicates the tip of the iceberg. That is so because hypothermia is very difficult to detect and diagnose and most doctors are not properly trained or equipped to diagnose it as the cause of death to specify on a certificate. Hypothermia itself may be part of a general pattern of ill health which led to death or a constituent cause. But it is there and it could have been removed.
The other thing which is noticeable here is that specific studies have been done to try to find out how elderly people live in present-day circumstances, and all the indications are that a great many of them are already suffering from cold. Whatever they die of, the fact is that cold has contributed to their death. In 1964 a research project suggested that something like 20,000 deaths a year were attributable to cold.
1709 Task Force has done a signally useful job in this area. An analysis of a number of people in eight London boroughs showed that 24 per cent. of them said they were too cold during the day, and only slightly fewer said they were too cold during the night when they were in bed. The major reason why they were so cold, the one which was given in almost every case, was that they were too poor to afford adequate heating. They had to make a choice of priorities, whether they bought food or whether they purchased fuel for heating. The choice was between eating and heating. It seems to me to be a total scandal that we should allow that state of affairs to continue for a day longer. Only 7 per cent. of those who were interviewed knew about the heating allowances from the Supplementary Benefits Commission. I will come in a moment to the take-up of the heating allowances, but it is no wonder the take-up is so bad if only 7 per cent. knew that the allowances existed.
The most definitive study of this whole problem was conducted by Dr. Fox and his associates, and they reported in the British Medical Journal of 27th January. The figures they produce indicate that something like 500,000 people in this country are at risk of injury to their health or to their life by reason of the inadequacy of their heating arrangements. It is this which I would like to cure.
There seem to be three possible ways of doing so. The first is that we should increase the old-age pension to the point where out of his pension every pensioner would be able easily to provide heating arrangements for himself. I would have thought that the House would agree that to be the best possible way in the most ideal circumstances. The answer which successive Governments have given to that argument is that we simply cannot afford to do it.
The TUC last autumn was arguing we ought to raise the old-age pension to £16 a week for a retired couple and £10 for a single person. In all conscience that is low enough, since it is less than half the national industrial earnings. If we were to do that the cost would be something like £1,200 million. It sounds at first like a colossal sum for any Govern- 1710 ment to afford. In fact it is sevenpence in the pound on income tax. When one recollects that only the year before last the Government took sixpence off income tax, the fact is that we can afford to pay it if we want to. It represents about half the increase in the gross national product in the last year alone. All that the nation needs to do is to say to itself "We who are in work, we who have fuel and fit bodies, will make this sacrifice not of our present standard of living but of an expectation of an increase in the future". We could do that right away.
§ Mr. Timothy Raison (Aylesbury)
I am merely seeking clarification. Are both the sevenpence and the sixpence that the hon. Member mentions in terms of new pence or old pence?
§ Mr. Lyon
Certainly the sevenpence is new pence, and my recollection is that the sixpence is new pence, too.
The position, therefore, is this. For the increase in the social security benefits next autumn, the Government have allocated about £540 million. If they had chosen to make available the £1,200 million which I have indicated would be necessary to provide reasonably for the old people, the cost to the average worker on the stamp would have been 6p instead of 2p. I would prefer that payments came from income tax, because income tax is indisputably the fairest tax possible, and national insurance contributions, even with earnings-related payments, are still much more regressive than income tax. However, if it is to be paid by these contributions, the contributions are not out of line for average industrial workers.
If that were rejected, the second possibility is that we should create a special heating allowance for every pensioner. In its study of the matter in the London boroughs, Task Force concluded that a proper heating allowance would be about £2.50 a week. That sum for every pensioner would mean a cost to the nation of £750 million. If we gave it only to those in receipt of supplementary benefit it would cost about £90 million. That would be about ½p on income tax. We can certainly afford that, and nobody should dispute it. It is hypocrisy to say that we cannot afford it.
1711 The third way in which we could tackle the problem is the way in which we tackle it now. This is by seeking out the areas of need and identifying those who are at present suffering from inadequate heating and trying to help them. Though we have been trying to do this for several years, the present figures indicate how lamentable our efforts have been. Therefore, it may be some criticism of this approach totally.
Already local authorities have power under Section 45 of the Health Services and Public Health Act 1968 to provide appliances for heating if they so wish. Circular 19/71 said that the Government would authorise the use of this power forcarrying out works of adaptation (in the home)… to secure greater safety, comfort or convenience".That would certainly include proper heating appliances.
In addition, under Section 45 the Minister is empowered to order local authorities to do it, although he has said he will not do that unless there is experience of greater need. I asked the Minister how many local authorities have used this power for the provision of heating appliances. He told me in a Written Answer that the figures were not available. However, he has told me in a letter written to me recently about my Bill that he is satisfied that local authorities are making every effort. I do not see how the two answers can be consistent. Either the Minister is satisfied that local authorities are making every effort or he does not know and we do not know whether they are making any effort.
What does the Minister intend to do to ensure that the powers under Section 45 are enforced by local authorities in relation to the provision of proper heating appliances? I have not very much expectation, because circular 19/71 was written in language which was almost designed to see that local authorities did not apply their power very widely. The circular says:The identification of need on the part of individuals and the provision of services for them must march together since there will be great disillusion and disappointment if inquiries reveal needs which are then left unmet. No scheme to identify the elderly in need of help should be undertaken without full consideration of the purposes it is intended to serve and"—1712 this is the important point—the expectation of immediate help which may be aroused.The effect of that would be that any local authority which was parsimonious would begin to look at its purse before it began to look at the need which had to be met and to devise its rules about the provision of heating appliances according to how much it felt it could afford. We must get past that if we are to adopt the third method of looking after the elderly.
Local authorities can provide the appliances. The Supplementary Benefits Commission can give the money to the old people so they can use the appliances, but it does so very inadequately. Within the necessary allowances for supplementary benefits the commission makes some notional provision for heating. In addition, the old person can claim heating allowances separately.
The heating allowances are restricted by a decision of the commission which is administrative and not compelled upon it by legislation. The commission said that the figures should be in each case either 30p, 60p or 90p and that only in the very rarest cases will it provide more than 90p in heating allowance.
As Task Force indicated, 90p is totally inadequate for the heating needs of old people who are in danger. Most of us who have anything to do with the matter, if only in relation to our own parents, know that it is adequate, and we also know that it is inadequate for those who come to see us and who complain of their need.
§ Mr. Raison
Of course these figures would be inadequate if they were the sole amounts allowed for heating by the commission, but the scale rates and the long-term addition both include significant elements for heating.
§ Mr. Lyon
I had already made the point about the basic element. The hon. Gentleman cannot tell me that, even with the new basic element of about £11.50, the amount which has been allowed for heating in that figure can be substantial. On the whole, those who are not pensioners spend about 5 per cent. of their income on heating. Those who are pensioners, spend, on the whole, 8 per cent. of their income on heating. If 8 per cent. of £11.50 is to be what is allowed 1713 for heating by the commission, it is a very inadequate part of the total, even taken with the full 90p that might be given to the elderly in heating allowances. In addition, the long-term addition is now not to be considered as part of the heating allowances under the new legislation.
The commission has restricted its heating allowances in this way, though it could pay the full heating costs of old people if it wished. Even so, only 159,000 people receive heating allowances out of 1.8 million people who are on supplementary benefit. Clearly, the take-up is grossly inadequate to the need, particularly in the light of the figures disclosed in the report by Dr. Fox.
Therefore, if we are to choose the third method—namely, identifying those in need and seeking to help them—we must do much more than simply give discretionary powers to the agencies. We must ensure that the agencies use those powers.
For that reason, when I came to draft the Bill I sought not to give the commission or local authorities any more powers than they have now but to ensure that they use them. The Bill would impose mandatory duties upon them—not that they may provide the old person either with appliances or with heating allowances, but that they must do so, provided that the old person is in such need that the general practitioner certifies that there is risk to his health by reason of the inadequacy of heating.
Clause 1 lays a statutory duty on all general practitioners to notify the director of social services of anybody who is in this state. I do not like any more than the Ministry apparently likes the idea of imposing a statutory duty upon general practitioners, but it seems to me to be the most effective way of dealing with the matter. It may be said that doctors would object to a statutory duty because it would breach the confidential relationship between themselves and their patients, but this already happens in relation to notifiable diseases when a disease is infectious and it is thought to be in the interests of the community that the disease should be notified to the medical officer of health. I am suggesting that we do no more than that.
I shall be prepared in Committee to accept any amendment to allow an old 1714 person to decide whether the general practitioner should communicate. Clearly, in this area of their social life it is for the old persons to decide, and I intended originally to allow for that protection of their privacy in the Bill, but I thought it better to leave it as it is at the moment in order that in Committee the matter can be discussed and we can get the right form of words to meet the point. I am, however, prepared to accept that point, and, subject to that, the general practitioner would notify the local authority. The local authority would then have to use its powers under Section 45 of the Health Services and Public Health Act 1968 or under any other statutory provision to provide the old person with a sufficient heating appliance to raise the heat in his home to 70 degrees Fahrenheit.
I chose 70 degrees deliberately because the Government, through the Department of the Environment, insist that, where local authorities build houses for old people, those houses should have heating appliances that will raise the temperature to 70 degrees. If it is to be done by local authorities in their provision for the elderly, why should it not be the right of every old person to have that degree of heating in his home? The medical authorities already insist that something of the order of 70 degrees Fahrenheit is requisite for old people in order to preserve their health, and it is for that reason that I have included it in the Bill so that it can be made more readily available.
§ Mr. W. R. Rees-Davies (Isle of Thanet)
Of course, it is true that in the provision of new housing one provides for an adequate and proper temperature. A temperature of 70 degrees has been suggested for new housing. But does not the hon. Gentleman recognise that in old housing with inadequate insulation it would involve in many cases the expenditure of hundreds of pounds on structural work to eliminate dampness and provide insulation in order to carry such a suggestion into effect? It is quite impracticable.
§ Mr. Lyon
If the hon. Gentleman is asking whether I realise that that is the case, the answer is "Yes". What I want to do through the Bill is to see 1715 that old people live in proper accommodation. There are already funds available through the improvement grant to ensure that they get that degree of comfort in accommodation to safeguard them against draughts and the inadequacy of the building. All I would say is that whatever kind of old house the hon. Gentleman may live in, if he wanted to install central heating the contractor would ensure that it would be capable of raising the temperature to 70 degrees Fahrenheit.
The result, therefore, is simply this. If the hon. Gentleman is prepared to pay out of his private income the money that will provide that degree of heating in his own house, even if it is old, the real question is whether the community is prepared to make available the sums of money required to make that kind of provision for every old person. I think we should. Indeed, it is for that reason that I have introduced the Bill.
Clause 2(2) makes provision for an old person to contribute some part of his income towards his own heating. I have chosen 5 per cent. of his income because, as I indicated earlier, that is the average amount which is spent by those of us who are in work and are earning in order to provide heating in our homes. Five per cent. of the present suplementary benefit scale would be something like 50p a week, and it might be reasonable to ask an old person to provide that from his pension, but it does not seem right that old persons should have to provide more.
Therefore, the difference between the 5 per cent. and what it actually costs to heat the home would have to be paid by somebody. I have laid the duty on the local authority because, in introducing a Private Member's Bill, I cannot lay it on anyone else. I cannot lay it on the national Government, upon which it ought to be laid. But I have laid it on the local authority in this way: the local authority must pay, and, unless the Government are prepared to introduce a Money Resolution to ensure that they will provide the grants to the local authorities to help them to pay, it would come out of the rates. The local authority must pay, subject to the fact that it can recoup part of the cost from the heating allowances which will be paid to the old 1716 person by the Supplementary Benefits Commission.
We shall be in a very changed situation if the Bill is allowed to go through. Instead of some frail old lady of 75 trying to find out about heating allowances and, not knowing much about them, going down to the supplementary benefits office and having to deal with a man behind the counter who may be charming and helpful, or quite the reverse, we would have a powerful local authority getting in touch with the Supplementary Benefits Commission and saying "We are having to pay for an old lady's home. She is desperately in need of some kind of heating allowance and we are having to pay something like £2 a week to heat her house. Why do you not pay her proper heating allowances?"
Even if the scales were still at a maximum of 90p, the local authority would get that 90p and the take-up would be immeasurably improved. Even more important, however, it would put pressure on the Supplementary Benefits Commission to raise the general level of heating allowances. That is what I want to be done.
I hope that if the Bill becomes law the Supplementary Benefits Commission will actually pay the weekly costs, but I cannot stipulate this myself as a Private Member. This is a device for seeing that that happens. It would not require a Money Resolution to do that because the Supplementary Benefits Commission already has the power to make these payments and to breach its own limit of 90p. That is what I intend it should do.
§ Mr. Raison
I am not clear on one point, namely, whether the 5 per cent. or more to which the hon. Gentleman refers embraces the capital cost or merely the running costs, or whether the assumption is that the whole of the capital cost will be dealt with under the other provisions and that this merely refers to the running costs.
§ Mr. Lyon
The provisions in the Bill are clear. The capital cost is dealt with by Clause 2(1) and the running costs are dealt with by Clause 2(2). I have broken it up in that way because I am dealing with the powers of the existing agencies. The local authority can provide only the capital requirements, and the Supplementary Benefits Commission can provide for 1717 running costs. I hope to deal with the matter in that way.
The Bill is a genuine attempt to deal with an important problem. I should welcome the Government's assistance in meeting the requirements on the principle of the Bill. I am prepared to consider any suitable amendments in Committee. I have deliberately drafted the Bill in a straightforward way, which will require some amendment at that stage, because I wanted to get the principle across. Moreover, I have strong views about the way we draft our legislation, and I have made this complaint to the parliamentary draftsmen on several occasions. We make our legislation far too complex, and I have been anxious that the Bill should not fall into that category because old people have to know about it.
As I say, I am prepared to consider any amendments in Committee. All I ask from the Government is that they deal with the matter on the basis of the principles of the Bill as introduced. If the principles are inadequate, let us discuss them. If, on the other hand, the principles are adequate, let us have no Committee points in an effort to defeat the essential requirements of the Bill. The matter is too urgent for that. We must ensure that not 100 people die a year, nor 7,000 die a year, but that no one in our society dies of cold in any year.
§ 3.0 p.m.
§ The Under-Secretary of State for Health and Social Security (Mr. Michael Alison)
The hon. Member for York (Mr. Alexander W. Lyon) suggested that we should deal with this subject on the basis of the Bill as presented. That I shall do, and I intervene at this stage only so that I do not interfere with the time which hon. Members on both sides may wish to use in contributing to the debate. I shall confine myself largely to the details which the hon. Gentleman sets forth in the Bill, but, since he began with a few general remarks about the need of this section of the population, I wish to say at the outset that I endorse the concern he expressed that there should be no hazard or suffering for people in this group in the Britain of the 1970s.
The hon. Gentleman was quite indiscriminate and fair in allocating blame for shortcomings on the part of public auth- 1718 orities and parties of whatever colour, but I think that the House will agree—I am sure that we cannot be challenged on this—that the Government, and my Department in particular, have shown more practical concern in measures, financial or practical, brought forward to help the groups encompassed by the Department of Health and Social Security than any Government since the war. Against that background I approach the details of the Bill which the hon. Gentleman has introduced.
Clause 1 places a duty on general practitioners to give notification to the director of social services if they believe that the health of any elderly person is, or is likely to be, seriously affected by the inadequacy of heating in his home. I must explain the reasons why we are not able to accept that. This is not a niggling Committee point; it is a major point of principle.
First, there is the small objection, which one is bound to raise since it will involve a change in the Bill, that the term "general practitioner", as the hon. Gentleman knows, may embrace three different types of practitioner. I presume that the hon. Gentleman means the medical practitioner, but there are general ophthalmic practitioners and general dental practitioners. [HON. MEMBERS: "Oh."] This is not irrelevant—
§ Mr. Alison
—it is not—because there are some old people in respect of whom the reference to general practitioner will not necessarily imply the general medical practitioner. Many elderly folk in a particular state of health will make more frequent use of a general dental practitioner or a practitioner dealing with their eyes than they will of the family doctor. We must be precise about it. I am sure that the sponsors of the Bill are thinking of the ordinary family doctor providing general medical services under the National Health Service Act, but it must be made clear, and we should have to attend to it.
A more substantial objection to this part of the clause relates to the specific duties and responsibilities of a general medical practitioner. These are set out in Schedule 1, Part I, to the National 1719 Health Service (General Medical and Pharmaceutical Services) Regulations, the well-known Statutory Instrument No. 1602 of 1972.
General practitioners are what we call in the National Health Service "contractors". In other words, they have a contract for services, not a contract of service. This is an important point of detail, because if it is a contract for services the services which the contractor is expected to render have to be agreed and spelled out in detail in regulations.
Very briefly, his duties can be summarised as being to render to his patients all necessary and appropriate personal medical services of the type usually provided by general medical practitioners. Such services include arrangements for referring patients as necessary to the hospital and specialist services, the general ophthalmic services and the local authority health services, andadvice to enable them to take advantage of the local authority social services.This wording was very carefully chosen and agreed with representatives of the profession in the course of the recent comprehensive revision of the regulations and terms of service and, in particular, the requirement that the doctor should advise his patient on how he should go about taking advantage of the local authority social services represents the agreed limit of his responsibilities in this direction.
In essence, the Bill aims to place upon general medical practitioners a duty in regard to something which is not strictly medical, or, if it is, belongs more to the province of the local medical officer of health. It would mean that at any time of the year a general practitioner would be under an obligation to inspect the heating in a patient's home—a most unreasonable requirement in view of the wide range of his duties and the pressure on him. It would also introduce a principle about notifying something an individual might not wish to be notified.
There are, of course, occasions when the general practitioner may initiate action, which may be unwelcome to his patient, simply for that patient's protection. But this proposal would go much wider than that. In any event, general practitioners are not equipped 1720 either materially or by experience to assess whether the accommodation inhabited by an elderly person is adequate.
There is, of course, nothing to stop the individual doctor from going beyond his formal responsibilities in a particular case, where, for example, he feels that his patient may not be capable, for whatever reason, of taking full advantage of the various forms of help now available through the welfare services, and has no younger relative or friend who would be able to help.
In such cases, he may personally go to a great deal of trouble on behalf of his patient; or he may need to do no more than mention the circumstances to a member of the local authority health or welfare staff—possibly one who has been attached to his practice for the very purpose of helping in the general management and care of his patients. It would, however, be wrong to seek to go beyond the present formal position, and to seek to impose a rigid pattern of additional responsibility on the family doctor in the way suggested in this Bill.
If this additional responsibility were to be imposed on NHS general medical practitioners, the proper, and only, way to do so would be to negotiate with the General Medical Services Committee of the BMA, the body representing general medical practitioners, an amendment to the terms of service that I have referred to in exactly the same way as we shall have to negotiate with it about, for example, the possibility of extending the scope of family planning services.
§ Mr. Alexander W. Lyon
Surely the Minister realises that general practitioners have a duty to notify certain kinds of infectious diseases. That is a statutory obligation upon every medical practitioner irrespective of whether he is employed by the NHS or not. That could be done without changing the context of the service.
§ Mr. Alison
That would not enable us to secure the objectives of the clause. Disease may arise at a later stage as a result of coldness, but in the first instance to require general practitioners to go round and inspect the premises would be expecting them to go far beyond the scope of their duty to notify about infectious diseases.
1721 This would not only make it easier, if we are to try to negotiate the necessary arrangements with the BMA, for the average family doctor to remain aware of his duties and responsibilities—and this is essential if we are to get the full effect of the Act. General medical practitioners have got to be able to participate through their elected representatives in the negotiations which are made about what precisely they are expected to do. It would also ensure that any failure to carry out this additional responsibility could be dealt with by the well-established procedures laid down in the National Health Service (Service Committee and Tribunal) Regulations 1956, as amended.
Briefly, these provide that if a patient, or the representative of a patient, considers that a doctor has failed to carry out his responsibilities under his terms of service, the patient may make a formal complaint to the appropriate executive council, which then has the duty—through certain of its committees—of investigating the complaint and taking suitable action if it finds the complaint to be justified. The Bill gives no indication of what would happen to any family doctor against whom it was alleged that he had failed to carry out the new duty imposed by Clause 1 —what penalties or actions he would be liable to.
Clause 2(1) places a duty on local authorities to ensure that any elderly person—denned in Clause 3 as any man over the age of 65 years and any woman over the age of 60 years—has heating appliances in his or her home capable of maintaining a temperature of 21°C or 70°F, in the living area, bathroom, bedroom and kitchen when the outside temperature is just under freezing point during the period the room is in use by that person.
The clause suggests the use of Section 45 of the Health Services and Public Health Act 1968 for the purpose of action needing to be taken by the local authority under this provision. In specifying the use of that Section, which the hon. Gentleman was at some pains to elaborate, the Bill at one and the same time recognises that powers to help the elderly are already held by local authorities' social service departments, but fails to take account of the important part played by 1722 local housing authorities in providing suitably heated housing for the elderly. Further, in specifying the achievement of a particular level of heating in certain rooms the Bill fails to appreciate the practical difficulties likely to be encountered in implementing such a statutory provision.
In 1969 a circular issued by the Department of the Environment required housing authorities and housing associations building new dwellings for occupation by elderly people to install heating appliances which would achieve the temperature set out in the Bill. The cost of doing so may be reckoned for subsidy under the Housing Finance Act 1972, as may the cost to housing authorities and housing associations of bringing their existing dwellings up to standard. Where an improvement grant it paid to local authorities or housing associations converting or improving property for old people, they are expected to achieve where possible the standards of the 1969 circular, including the provision of central heating. Thus the provisions of the Bill could well cut across existing work being done by district housing authorities under separate financial arrangements, and that would be quite wrong.
The Bill requires that the heating appliances shall be capable of maintaining a specified level of temperature in certain parts of the houseduring the period when the room is in use by that person".In theory this requirement could probably be satisfied in most households by the provision of a single, moveable, two-bar electric fire. But presumably that is not what the Bill intends, and its real aim is to bring the general standard of heating in an elderly person's home up to a level equivalent to that of a new, usually centrally heated, dwelling for elderly people provided by local or public authorities.
§ Mr. Rees-Davies
Can my hon. Friend say definitely, then, that under present practice the local authorities could, if they wished, bring the accommodation up to the standard envisaged by the hon. Member for York (Mr. Alexander W. Lyon)?
§ Mr. Alison
Subject only to the limitation on resources, which is implicit in the Bill.
1723 It is one thing to stipulate that a certain level of temperature must be achieved in a new dwelling and quite another to try to impose such a level by law in respect of any type of housing accommodation irrespective of its age or condition. The maintenance of a specified temperature level is not simply a matter of heating appliances. There is the all-important problem of dampness and insulation. Thus, in an average sized room of 100 sq. ft. a 2-kilowatt fire might be sufficient to maintain the temperature level specified in the Bill but not if there were poor wall or window insulation.
Most elderly people probably have satisfactory heating appliances of some kind, but to ensure compliance with the provisions in the Bill it would most likely be found necessary in many cases not only to provide completely new installations—which alone might cost in the region of at least £150 to £180 per unit—but to undertake structural improvements, insulation, draught-proofing or other works. The total cost of this would be quite considerable, and even if such expense were incurred there could be no guarantee that the person concerned would use the improved heating provision in the manner and to the extent required to maintain temperatures at the specified level.
§ Mr. Lyon
The Minister has not read the Bill. It says that local authorities should provide appliances capable of achieving this temperature. It does not say that the temperature shall always be at such-and-such a rate. The temperature would depend on what the old people wanted. But the point is that they should have in their houses appliances which are capable of achieving the temperature. That is all the provision says.
§ Mr. Alison
We are concerned to provide some means of ensuring that old folk in all possible circumstances are provided, in terms of the structure of the building, their resources and the appliances available for heating, with the combination of temperature which will secure that they survive the winter.
The maintenance of temperature at a specified level is particularly difficult to 1724 achieve in bedrooms where many elderly people will not entertain the idea of heating and may even leave their windows open all night, however cold the temperature.
A further point, as was shown in the recent survey report on hypothermia by Dr. Fox in the British Medical Journal, is that, whether or not the heating in an elderly persons home is sufficient when fully operative, the temperature in any one room may be low when the person first enters it in the morning or evening to switch on the appliances.
The hon. Gentleman will know from Dr. Fox's survey that this is a not unimportant point in relation to elderly people, who are extremely vulnerable when they are near the borders of the hypothermia danger level. The House will be interested to learn that Dr. Fox will shortly visit my Department for a series of discussions on the precise implications of the survey, many of which remain in some degree obscure. I am advised that there is no correlation between body temperature or temperature outside indicated by any of the figures produced by Dr. Fox in the survey.
The results of the survey made it clear that further work is necessary to demonstrate the measure and extent of the link-between heating provision, hypothermia and low body temperature. The survey found an extremely low incidence of hypothermia—only nine cases out of the 1,020 studied, less than 0.1 per cent. Those cases were not wholly hypothermia Although they were found to have abnormally low deep body temperatures in the morning, they were above hypothermic level in the evening The authors themselves considered it would be unwise to make firm projections from these findings of the incidence of hypothermia for the population as a whole because of the variation found in body temperature at different times of the day.
It is true that the survey also found that about 10 per cent. of those studied— 97 out of 1,020—had lower deep body temperatures than normal. Whilst this may constitute a health risk in that it could lower resistance to infection and may lead to serious hypothermia, especially when the person does not perceive his surroundings to be dangerously cold, it would be premature to conclude that 10 1725 per cent. of the elderly are at risk of developing hypothermia or that there exists a serious or widespread hazard to life.
None the less the Department recognises that steps need to be taken to enable the elderly to keep warm in winter. To this end, jointly with the Department of the Environment, a circular was issued to local authorities last autumn asking them to consider what action may be desirable and practicable in their areas to help deal with this problem. However, it had to be recognised that the action required to meet the needs of all elderly people would, clearly, be long-term and could only be taken to the extent that the many demands on manpower and other resources allow. It was suggested that the elderly at greatest risk of inadequate heating in their homes were possibly those in the less active higher age groups—75 and over—living alone, including elderly couples living alone, and particularly those who are housebound or severely handicapped. Authorities might therefore well decide that this group should first receive the closest and earliest attention.
There was no suggestion that the cost should necessarily fall on the local authority social services department; rather than, in the case of private dwellings, volunteers might undertake the work and the owner, landlord or tenant as appropriate may be ready to meet the cost. In relation to public sector housing, the matter would fall to be dealt with by the local housing authority. Mention was made in the circular of possible scope for an improvement grant or rehousing as a solution of the problem in some cases. It also said that the Supplementary Benefits Commission might be able to help where the person concerned was in receipt of supplementary benefit.
A leaflet, "Keeping Warm in Winter", issued to all local authorities, provides simple guidance notes for those engaged in helping elderly people. The leaflet recognises that it may not be possible with the available resources, whether the occupier's, the local authority's or any one else's, adequately to heat the whole of an old person's house or flat during the coldest spells in winter, but suggests 1726 the possibility of choosing a suitable room or rooms, or for that matter part of a room, where the occupier can keep sufficiently warm at a reasonable cost. The leaflet does not go as far as the Bill in that it suggests that it is principally the living room temperature which needs to be kept at about 21°C when the outside temperature is below freezing. It does, however, go on to say that, where possible, bathrooms and bedrooms should be kept either at the same temperature or, in any event, warm. It points out that sufficient bed clothes and a hot water bottle may keep an old person comfortable in bed provided the bedroom windows are closed and the bedding is dry.
The leaflet advises on a number of simple steps that can be taken to minimise the unpleasant effect of draughts which can make a room feel uncomfortable even when warm. I will not list the specific remedial steps which can be taken for an individual, but no doubt the hon. Member has seen the leaflet. However, adequate ventilation is essential to avoid stuffiness and to supply air for heating appliance combustion. This point may be overlooked if care and attention is not paid to particular premises.
The hon. Member referred to a recent answer I gave him. We know from our regional social work people that local authorities are helping with heating provision. We have not said that we are satisfied with what the local authorities are doing because we do not have the full statistics. Until we can review progress, it would be premature for any form of direction, such as the hon. Member asked for, to be given to local authorities.
Statistics are far from fully satisfactory in relation to the activities of local authorities. We need more statistics, but we are hesitant to press for them, since this work involves considerable surveys. They already have to do such work under a number of statutes, including the Chronically Sick and Disabled Persons Act. They are at the moment reorganising their social service departments and they are about to enter local government reorganisation. Whether we can implement the statistics as rapidly as may be desired is still uncertain. Until we have a full range of statistics, it would be premature to attempt this.
1727 But local authorities are aware of the importance of this job, and there is no reason to believe that they are not doing their utmost within the resources available to them. Assurances have also been given by a number of voluntary bodies of their willingness to co-operate in the implementation of local programmes. In the circumstances there seems no necessity to impose a statutory requirement on them to do what they already have power to do and what we know they are doing to the best of their ability.
Here it might be pointed out that Section 45 of the Health Service and Public Health Act 1968, referred to in Clause 2(1), is a wide-ranging power given to local social service authorities which enables them, subject to the approval of the Secretary of State, to make arrangements for providing for the welfare of old people. Formal approval has been given by way of DHSS Circular 19/71 to arrangements being made within a broad framework which give social service departments full scope for developing a comprehensive range of services to help elderly people. Of particular interest in the context of the Bill is the approval of arrangements to assist where appropriate in the provision of facilities to secure the greater safety, comfort or convenience of elderly people.
Thus, without the Bill, social service departments may, where they feel an elderly person's need to be best met in that way, provide or assist in the provision of new or replacement heating appliances. But Section 45 is intended to allow local authorities to consider the overall needs of elderly people within very much broader terms of references than simply the need for additional warmth—important though this is—and it would hamper such an approach if the resources, financial and manpower, were largely pre-empted for one specific purpose over all others. In the last year for which figures are available—the year ended 1971/72—local authorities in England spent a total of £12 million on services under Section 45. Of this about £4½ million was spent on meals services, about £1.9 million on recreational facilities, nearly £4½ million on general social work and £1.3 million on other services.
This expenditure is, of necessity, largely focused on the most frail and most vulnerable old people. By contrast the Bill, 1728 by virtue of the opportunity it provides for pressure to be placed on general practitioners, may eventually lead to a situation where anyone above pensionable age can have an almost automatic entitlement to help with heating provision and this at possibly considerable expense but with very little likelihood that more than a very tiny proportion would be well spent in preventing unnecessary illness and discomfort among elderly people.
Clause 2(2) requires local authorities to contribute to the running costs of heating appliances required to bring the temperature up to the level specified in Clause 2(1) but the intentions of the Bill on this point are obscure.
Clause 2(2) seems to envisage that a person should be expected to spend up to 5 per cent. of his total income on heating to the specified standard, and that the local authority should make up the difference between that amount and the actual expenditure incurred less any heating allowance given by the Supplementary Benefits Commission. The low figure of 5 per cent. has presumably been chosen with the object of ensuring that local authority payments are relatively generous. It is certainly lower than the proportion of their income which old people actually spend on heating. But it is certainly not self-evident that 5 per cent. is the right figure. It is not clear, moreover, whether local authority help would be given on a weekly, monthly or annual basis—presumably it would be weekly, in line with supplementary benefit. There should be little difficulty in calculating 5 per cent. of a person's total income. To ascertain the actual expenditure on fuel in every case would, however, be a substantial task, requiring, unavoidably, old people to keep their bills for inspection.
The hon. Gentleman has gone in for means testing. It means that old people would have to do the necessary paperwork. It would be necessary to provide that only expenditure which was reasonable in relation to the accommodation and equipment concerned would be reimbursed, so that local authorities would not have to underwrite profligate expenditure. All this would involve a substantial bureaucratic operation.
It is also not clear what is meant by "any heating allowance" given by the 1729 Supplementary Benefits Commission. Does this mean the total amount of supplementary benefit provision for heating, which includes part of the basic scale rate; or does it mean only the discretionary additions for heating which can be made where a person has exceptional heating expenses? If the former, it would be necessary to specify the amount within the basic scale rate which was attributable to heating, but this would be arbitrary and unfair because in practice people spend different amounts on heating. If the latter, those who do not receive a discretionary addition, either because they do not claim or because they do not know about the help available, would get more from the local authority than those who do receive such an addition, and would, therefore, have it deducted before deciding how much the local authority should pay. Moreover, since the Bill does not exclude them, retirement pensioners who are not on supplementary benefit would appear to quality for help with heating costs from the local authority, but they would not be affected by the requirement to deduct any heating allowance given by the Supplementary Benefits Commission. Thus 5.5 million retirement pensioners above the supplementary benefit level would get more from local authorities than 2.2 million pensioners actually on supplementary benefit. In other words, more would be given to those who already have more. It is thus clear that Clause 2(2) has not been properly thought out and would produce unacceptable anomalies.
More important, the Bill ignores the fact that the supplementary benefits scheme already provides for heating costs. As already noted, the basic scale rates contain provision for normal heating expenses. The scale rates for supplementary benefit pensioners are being increased by £1 single and £1.60 married next October, well in excess of the amount needed to compensate for price increases. These increases will, therefore, enable supplementary pensioners to spend more on fuel than hitherto. Moreover, where a person has exceptional heating needs and expenses because of the state of his health or accommodation, or both, heating allowances can be paid at the rate of 30p, 60p or 90p a week under the Supplementary Benefits Commission's dis- 1730 cretionary powers. Full details are given in the leaflet "Provision for Heating", which was issued to local authorities and voluntary bodies last autumn, to help them advise old people at risk. These allowances were increased by 20 per cent. in 1972, and the criteria of entitlement were widened in 1971. The Supplementary Benefits Commission keeps both the amounts and the criteria under review, and it has just introduced a more direct and systematic approach to identifying extra expenses.
As from October this year, under a special provision in the National Insurance and Supplementary Benefit Bill, these heating allowances will be payable in full on top of the long-term supplementary benefit scale rates, instead of, as hitherto, being offset against the long-term addition. For many people this offsetting has meant that, although they have recognised extra expenses on heating, they have not received a heating allowance because the expenses have been covered by the long-term addition. The change, which has been urged on the Government by such bodies as Age Concern and the Child Poverty Action Group, is expected to benefit up to 400,000 people in all at a cost of about £6 million a year. It is an indication of the Government's awareness of the heating problems of old people and of their determination to take action to deal with them.
§ Mr. Alexander W. Lyon
CPAG, which brought the legal action which prompted this change, tells me in correspondence that Lord Collison takes the view that if people have heating allowances in full their long-term addition will be reduced. I hope that is not the Government's intention.
§ Mr. Alison
The Government's intention, as I have already said, is as it appears in the Bill. The hon. Gentleman stated when he introduced the Bill, although he made some general comments about the background and the different ways he thought we might approach the problem, that he wanted the provisions of the Bill to represent an instrument in principle which would be suitable for making the changes that he wanted.
I have deliberately considered the Bill in detail and given it a fair scrutiny. My 1731 conclusion is that it is not a suitable vehicle for seeking to make changes so immense in an area where we all want to do more if we possibly can. A great many of the powers which the hon. Gentleman wishes to bring forward are in the hands of local authorities, and on a more flexible basis than that which the Bill poses.
That is particularly true in respect of the crucial contact point of general prac-tioners under their existing contracts of service. It would be wrong to legislate in advance of discussions with the BMA. It is almost certain that general prac-tioners would refuse to operate, as part of their contracts of service, such wide-ranging responsibilities as having to be ultimately responsible for the possible cause of death resulting from hypothermia and for failing to have gone to a house to assess whether it contained a person to whom reference should be made to the director of social services. The Bill does not contain the terms of the penalties which should be imposed in the event of a failure by the general practitioner concerned.
It is for those reasons that I cannot recommend the House to give a Second Reading to the Bill.
§ Mr. George Cunningham (Islington, South-West)
The hon. Gentleman spoke about imposing upon medical practitioners a duty to report. If a medical practitioner is unaware that a registered patient has a certifiable disease, he cannot be prosecuted for not having gone to that person's house, not having had any reason to do so. Surely that takes care of the point.
§ Mr. Alison
Hardly. Clause 1 refers toA general practitioner who has reasonable grounds for believing that the health of an elderly person is, or is likely to be, seriously affected.There will be ample scope for litigation and prosecution if a general duty of that sort is laid on general practitioners. It is unlikely that the profession would be prepared to accept that in any negotiations about contracts of service. So sweeping and general a duty could not be laid upon medical practitioners by this House without the most far-reaching discussions with the profession.
§ 3.36 p.m.
§ Mr. Alfred Morris (Manchester, Wythenshawe)
This is a small Bill, with a big and clearly humane purpose. It is a measure whose aim it is to end preventable suffering and to improve the quality and dignity of life among elderly people in need.
The Under-Secretary of State made some bold points. He says that he is opposed to my hon. Friend's Bill because it is not a suitable vehicle by which to achieve his purpose. We on this side of the House are becoming tired of the vehicular excuse from the present Government. The hon. Gentleman even sought to congratulate the Government, and by implication himself, in a remarkably blue passage of his speech. I shall return briefly later to what he said.
First, I should like warmly to congratulate my hon. Friend the Member for York (Mr. Alexander W. Lyon) on promoting what I believe the House as a whole should regard as a worthy and necessary Bill of deep human importance. The drafting of the Bill may not be incapable of improvement. This he concedes, but any constructive amendments put forward in Committee will be accepted by my hon. Friend.
It is wholly typical of my hon. Friend that he should introduce a measure of this kind. We all appreciate that he is a man with a very genuine and abiding sense of social concern. Almost my first discussion with him after he entered the House—at the time we were both youngish new Members—was about a hard-pressed woman in his constituency. Her husband, who had for long been disabled, had recently died and she was left to care for several young children. My hon. Friend was, clearly, much moved by the suffering of this unfortunate lady. From my knowledge of my hon. Friend's work on the case, I must say that she was fortunate to have as her Member of Parliament someone who was so determined to help.
As my hon. Friend has recognised, it may be argued that the answer is not to provide benefits of the kind suggested in the Bill but, instead, to increase retirement pensions to an adequate level. That may be so, but there is no immediate prospect of it happening. We on this side of the House have argued for a 1733 pension of £10 a week for a single person and £16 for a married couple, but our proposals have been rejected by the Government.
Earlier this week there was a Second Reading debate on the National Insurance and Supplementary Benefit Bill.
§ Mr. Alison
As the hon. Gentleman is speaking from the Front Bench, may I ask whether, in the context of the request for the uprating of pensions, he can guarantee that immediately on being voted to office the Labour Party will raise pensions to that level or by the same proportion in relation to the value of money at that time? Will that be done immediately on assuming office, or will pensioners have to wait for a while?
§ Mr. Morris
One of the first actions of the Labour Government on being returned to office in 1964 was to improve the standard of living of retirement pensioners. Again and again we have emphasised the need for urgency to improve their standard of living. As I am sure the hon. Gentleman recognises, I cannot extend this debate to one about pensions, but our proposals were both firm and sincere. The hon. Gentleman spoke at some length. I shall try to speak much more briefly.
Let the hon. Gentleman note that a spokesman for Age Concern has said that the latest proposed increase in retirement pensions… represents the smallest possible increase the Chancellor could have madeThere has been an explosion in food prices under this Government. In the first quarter of the present year, there was a movement of food prices equal to an annual increase of 22.8 per cent. Since stage 1 of the Government's so-called prices and incomes policy came into force, meat prices have rocketed by 40 per cent. This is utterly shocking. My hon. Friend rightly emphasised that for some elderly people the choice is between eating and heating. Far too many old people now have the very sombre choice between buying a meal and lighting a fire.
At the same time, they are advised by successive Ministers of Agriculture in the present Government to shop around if food is too dear. If most elderly people shopped around from Lands End to John 1734 o' Groats they would not find food at prices they can afford.
The Under-Secretary of State referred to Dr. Fox's survey, which was reported in a paper on "Body temperatures in the elderly" and published in the British Medical Journal of 27th January 1973. If the hon. Gentleman is aware of this important paper, why is he doing nothing about it?
We find that two large-scale surveys—
§ Mr. Alison
I said that we have asked Dr. Fox to come into the Department to have full discussions with us on some of the detailed implications of the paper.
§ Mr. Morris
I hope the hon. Gentleman will show a much greater sense of urgency in acting on the findings of this important research.
Two large-scale surveys of body temperatures in the elderly living at home were carried out in the winter of 1972. Most of the homes visited were cold, with room temperatures below the minimum recommended by the Department. Deep body temperatures below 35.5°C were found in 10 per cent. of those studied, and the difference between the skin temperature and the core temperature was also reduced in this group. We know that such individuals are at risk of developing hypothermia, since they show evidence of some degree of thermoregulatory failure. Further research is needed, but meanwhile there are practical measures which could be taken to reduce the risk of hypothermia in the elderly. My hon. Friend's Bill is just such a measure.
Many on both sides of the House have been deeply shocked by the findings of the survey. I say again that I hope the Minister will see Dr. Fox at the earliest possible date and decide what action should be taken, in the very near future, to avoid any repetition of the tragedies of last winter.
We appreciate that extra cost is involved in my hon. Friend's Bill. It does cost more money to keep people alive. Our point is that we oppose the alternative of unnecessary deaths. If a Money Resolution is required for the Bill, I hope that the Chancellor will help my hon. Friend by tabling a suitable resolution.
1735 I appeal to hon. Gentlemen on both sides of the House to give this Bill a fair wind. My hon. Friend has made a compelling case for the Bill. There is time now for me to speak only very briefly. It is always easy for Governments to think of reasons why improvements should not take place at a particular time. We believe that the Bill is of vital importance if more elderly people are not to die preventably during the next winter, as so many elderly people died during the winter of 1972–73.
The Under-Secretary criticised my hon. Friend for placing new responsibilities on the medical profession. All my hon. Friend was saying was that where, in the normal course of his duties, a doctor found a person in need, as defined in the Bill, the doctor should help. It is not necessary for the Under-Secretary to make a big issue of this. My hon. Friend said again and again that he was prepared to consider any amendments to improve the Bill. I am satisfied that most hon. Members on both sides of the House would want the Bill to go forward, and I hope that no one will be responsible for delaying its passage today.
§ 3.46 p.m.
§ Mr. Timothy Raison (Aylesbury)
The House is agreed on the serious need for improving the condition of old people and accepts that heating ranks high among the problems facing them. We know that old people tend to feel cold more than other people do and that they tend to be less well off financially than others, and often they live in houses that are old, damp and draughty. Old people in the nature of things are liable to have less energy to put things right themselves and are naturally not so good at "do it yourself", and they have less energy for getting other people to put things right for them when those things should be put right.
I do not think that anybody would dispute the seriousness of the subject, nor the value of the debate today in that it has drawn attention to an important problem and elicited certain useful information. But we have to face the question of whether the Bill would bring an appreciable improvement in the situation and whether its provisions are reasonable. I do not believe that it passes those tests.
1736 It is not only that there are faults that may be put right. We all accept that if the general pattern of a Bill makes sense, some things may be put right in Committee. I agree with my hon. Friend the Under-Secretary that there are serious deficiencies in the substance of the Bill. This is one of those classic cases where one has to separate genuinely good intentions, put forward in all honesty, from the possible consequences of the Bill. One has to ask whether this is the right way in which to go about solving what we all know to be a serious problem.
My hon. Friend the Under-Secretary talked about the different elements in our approach to the problem and he spoke about the provision of advice. He quoted the leaflet on the subject put out by his Department some time ago and making the important point that what is at stake is often not a matter of financial resources but the fact that people do not know how to make the best use of what is available, and that they particularly do not know how to organise their households so as to get the maximum benefit from such heating as they have and the building itself. We all know that giving advice is an important part of what has to be done.
The leaflet was addressed to social workers and others visiting the households of old people. It seems to be eminently sensible for it to be more widely distributed. Could not my hon. Friend take steps to ensure that it has wider distribution beyond the strictly agency world for which it was primarily designed?
Then my hon. Friend spoke a little about the housing requirements, which are important—the fact that regulations now ensure that at least new local authority and housing association houses are built to a certain standard of heating, in fact to the standard which the hon. Gentleman adopts in the Bill.
My hon. Friend legitimately outlined the financial help we give for this category. The hon. Member for York (Mr. Alexander W. Lyon) was a little cavalier on one point, on which I intervened; the hon. Gentleman seemed to be equating 6d. with 7p. The tax cut was 2½p or 6d., but the hon. Gentleman was talking about an increase of 7p, which was a little naughty of him.
1737 My hon. Friend covered the basic and important question of just what we are doing in terms of financial provision for heating. He particularly made the point that the supplementary benefit scale rate and the additional charge both include a heating allowance and that from October next that heating allowance will be added to the other allowances and will in no sense detract from them.
Although I know that the hon. Gentleman's intentions are serious, I do not think that the Bill has the stamp of one which is seriously intended to become an Act. There are too many signs of carelessness about it, of its not having been thought through. One quite understands that an hon. Member who does not come all that high in the Ballot might put forward a Bill which commands a certain amount of instinctive public sympathy and that he might not take a great deal of trouble about its structuring. There are deficiencies in the Bill which justify my suggestion that it has not been thought out as seriously as it should have ben.
§ Mr. George Cunningham
It is not for me to defend my hon. Friend the Member for York (Mr. Alexander W. Lyon), who is well able to defend himself. However, I must point out to the hon. Gentleman that when the Heavy Commercial Vehicles (Controls and Regulations) Bill was introduced as a Private Member's Bill, it, like this Bill, had to be structured in an unsatisfactory way. Because of the limitations on a Private Member's Bill perhaps, the Government gave their support in principle. As a result, the Bill was totally rewritten and restructured in Committee. If there is support in principle for the Bill, on the precedent I have quoted the whole thing could be changed, with Government backing.
§ Mr. Alison
Will my hon. Friend the Member for Aylesbury (Mr. Raison) inquire in terms of the sponsor of the Bill whether he has seriously thought out the general practitioner implications and whether he had discussions with the British Medical Association about those implications before introducing the Bill? It would be impossible to get the necessary negotiations with the British Medical Association through within the time scale for Private Members' Bills.
§ Mr. Raison
That is a valid point. The hon. Member for Islington, South-West (Mr. George Cunningham) said that it is sufficient to name a topic and expect to be able to build a Bill on it afterwards. That is not so. I turn to what I believe —[Interruption.] It would at least be wise of hon. Members opposite to listen to the arguments I am trying to advance before they sweep them out of court.
There are major objections to the Bill, one of which has just been touched on again by my hon. Friend the Undersecretary, and one of which has not so far arisen in the debate. I am against the increasing tendency to impose on doctors duties which are not strictly medical. It is not a sound principle to treat doctors as agents of social policy rather than of medical policy.
This tendency has been developing in important spheres, particularly in family planning. My hon. Friend the Undersecretary knows only too well that in the debate on Clause 4 of the National Health Service Reorganisation Bill in Standing Committee—Clause 4 deals with the extension of family planning practicesI said that one of the serious problems about the clause is that it uses doctors as instruments of social policy rather than as true medical practitioners. I am not saying this is an easy thing to answer, but it is a serious point. It is questionable whether it is justifiable to impose requirements on doctors to act as agents for social policy in this way.
It is absolutely fair and legitimate for my hon. Friend to make the point that to toss out this sort of idea without any kind of discussion with the medical profession is not acceptable. I regard this as a very serious clause and not a mere Committee debating point. Of course, as my hon. Friend has said, we accept that if a doctor discovers that an old person's house is seriously inadequately heated and if he is concerned with the possible medical implications, it is a very good thing for him to notify the appropriate authorities. But to move from that on to the laying on the medical profession of some duty of this kind seems to me to be a step which one would have to think about very carefully indeed.
§ Mr. Rees-Davies
Will my hon. Friend also stress the fact that a great many 1739 doctors get in touch with the social security people and ensure that heating is provided by the Supplementary Benefits Commission in many appropriate cases?
§ Mr. Raison
I am grateful to my hon. Friend. That is a valid point.
I will conclude on this first point by saying that one would have to think very hard about the sanctions which would be imposed on doctors who failed to carry out this duty.
Let me come to the second point, a point which has not been brought out in the debate—
§ Mr. Alexander W. Lyon
rose in his place and claimed to move, That the Question be now put, but Mr. DEPUTY SPEAKER withheld his assent and declined then to put that Question.
§ Mr. Lyon
On a point of order, Mr. Deputy Speaker. Would you consider the situation in which, before this Bill was discussed, two and a half hours of the time of the House was devoted to a Bill which was agreed by everyone, a Bill to which there were no amendments, which was put down for the Committee stage in the House a fortnight ago by agreement with the Gov-ernment on a motion that was not opposed, when the sponsor of the Bill, a Conservative back-bench Member, took 41 minutes to debate a clause in an agreed measure, and then made a Third Reading speech for about 25 minutes, in order to frustrate this Bill that was designed to help half a million old people who would otherwise die? If there was ever a reason for granting the closure, Mr. Deputy Speaker, surely there is a reason now for granting the closure on this issue.
§ Mr. Alfred Morris
With great respect, Mr. Deputy Speaker, you will appreciate that there is very strong feeling on this side of the House. Is there no possibility whatever of reaching a decision on this deeply humane and important Bill? We feel that this measure is being ruthlessly talked out, bearing in mind what was done earlier today. Is there any possibility of helping us to come to a decision on this important matter?
§ Mr. Deputy Speaker (Mr. E. L. Mallalieu)
It would not be in accord- 1740 ance with precedent to grant a closure on a Second Reading debate when the debate has gone for so short a period as this one has.
§ Mr. George Cunningham
On a point of order, Mr. Deputy Speaker. May I point out to you that before the hon. Member for Aylesbury (Mr. Raison) rose, only one other Member wanted to speak on this Bill, and that was myself.
§ Mr. Cunningham
Oh, yes. I am quite happy to yield my right to speak, and, therefore, all we would be denied would be the tail end of the hon. Gentleman's speech.
§ Mr. Raison
The other major point is that Clause 2 depends on Clause 1. There is a very serious deficiency here— [Interruption.]
§ It being Four o'clock, the debate stood adjourned.
§ Debate to be resumed upon Friday next.